Surgical ethics : principles and practice

Preface
Contents
Contributors
Part I: Principles and Foundations of Surgical Ethics
	History and Development of Medical Ethics In the West
		Introduction: From Professional Ethics to Bioethics
		Emergence of Medical Ethics, But Not Yet Bioethics
		The Beginning of Bioethics
		Conclusion: The Role of the Bioethicist
		Concluding Remarks
		Bibliography
			Suggested Literature
	The History of Surgical Ethics
		Introduction
		Birth of Modern Ethics
			John Gregory (1724–1773)
			Thomas Percival (1740–1804)
		Birth of Modern Surgery
		Surgical Ethics
		Informed Consent
		Transplant Surgery
		Surgical Innovation
		Surgical Ethics Today
		Conclusion
		Concluding Remarks
		Glossary
		References
		Suggested Literature
	Surgical Ethics: Theory and Practice Background
		What Does It Mean for a Practicing Surgeon to Be “Ethical”?
		Where Is “Ethics” in the Complexities of Patient Care?
		Why Do Well-Intentioned Individuals Come to Conflicting Judgments About What Should Be Done?
		What Are Patients and Their Families Invited to Trust?
		When/Why Does Trust Break Down in Patient Care?
		When/How Should Patients and Their Families Be Involved in Decision-Making?
		Why Is It So Hard to Keep Sense in Care at Life’s End?
		Is Concern for Justice (Ir)Relevant at the Bedside?
		“Who Cares…Really?”
		Appendix 1
		Appendix 2
		Appendix 3
		Appendix 4
		References
	Foundations and Principles of Surgical Ethics
		Beneficence
		Nonmaleficence
		Respect for Autonomy
		Justice
		Concluding Remarks
		References
	The Ethical Challenges of Surgical Leadership
		The Ethical Challenges of Surgical Leadership
		Leaders and Followers
			The Surgeon as a Leader
			The Distinctive Attributes of the Surgical Leader
		Ethics
		Ethics Is Paramount to Leadership
		Ethical Leadership
			Teleological Assessment
				Ethical Egoism
				Utilitarianism
				Altruism
			Deontological Assessment
			Virtue-Based Approach
				Creating an Ethical Culture
		Examining Bad Leadership
		The Six Major Challenges of Leadership
			Management of Power
			Management of Privilege
			Management of Information
			Consistent Decision-Making
			Loyalty
			Responsibility
		Ethical Decision-Making
			Moral Sensitivity
			Moral Judgment
			Moral Focus
			Moral Character
		Summary
		References
			Suggested Reading
	What Is Surgical Professionalism?
		Paternalism Versus Patient Autonomy
		Payment Model
		The Rise of Technology in Medicine and Surgery
		Commercialization of Health Care
		Appropriate Limitations to Practice and Responsibility to Keep Up To Date
		Fear of Malpractice Litigation
		Failure of Systems-Based Practice
		Self-Regulation: The Code of Silence
		Competition
		Conflict of Interest
		Solutions
		Concluding Remarks
		References
			Suggested Literature
	Ethics in Academic Surgery
		Introduction
		Human Subjects Research
			Historical Development
			Ethical Requirements for Clinical Research
			Informed Consent
		Surgical Innovation
		Research Integrity and Publication
			Good Research Practices
			Authorship
		Conflicts of Interest
		Mentorship
		Conclusion: Ethics as a Continuing Endeavor
		References
			Suggested Reading
	Ethical Issues of the Mentor-Mentee Relationship
		Concluding Remarks
		References
	Surgical Ethics and the Surgical Societies: What Are We Doing?
		Introduction
		Professional Surgical Societies
		Ethics in Surgical Professional Organizations
		Controversies in How Surgical Societies Handle Ethical Issues
		Concluding Remarks
		References
	Ethical Issues in Surgical Research
		Historical Perspective
		Unifying Principles of Ethical Research Conduct
		Intrinsic Barriers to Ethical Surgical Research
		Pathways to Ethical Innovation
		Special Considerations
			Quality Improvement
			Communication During Informed Consent
			Sham Procedures
			Industry Relationships
			Authorship
		Ethical Concerns for the “Basic Science” Surgeon-Investigator
		Concluding Remarks
		Glossary
		References
		Suggested Literature
	Surgical Ethics and Diversity
		Introduction
		Lessons Learned from Business
		The Social Contract of Diversity
		Issues with Diversity in Surgery
			Healthcare Disparities
			Surgical Workforce
		Response from Healthcare
		Cultural Barriers
			Bias
		Path Forward
			Cultural Competence
			A Personal Commitment to Diversity
		Concluding Remarks
		Glossary
		References
		Suggested Literature
	Why and How to Teach Surgical Ethics?
		Introduction
		Why
		How
			Case-Based Format
			Formal Curriculum
			Incorporating Ethics into M&M
			Conclusion
		References
	The Surgeon, the Patient, and the Healthcare System: Access, Equity, and Fairness
		Introduction
		Introduction to Terms
		Just Access Within Nations
		Institutions
		Justice in Global Health
		The Individual Surgeon’s Obligation
		Conclusion
		Works Cited
	Ethics in Global Surgery
		Introduction
		The Burden of Surgical Disease
		The Making of Essential Global Surgery
		Quality of Surgical Care in LMICs
		Organizational Ethics and Global Surgery
		Assessing Ethical Issues in Global Surgery
		Determining a Course of Action
		References
	The Anesthesiologist and the Surgeon: Two Professionals Sharing the Command of the Patient in the Operating Room
		Introduction
		Human Rights
		Ethical Principles
			Autonomy
			Beneficence
			Nonmaleficence
			Justice
		Health Equity
		Professionalism
		Leadership
		Surgeon-Anesthesiologist Relationship and Aligned Goals
		Different Perspectives and Viewpoints
		High-Risk Patients
		International Health Ethics
		Summary
		References
Part II: Surgical Ethics in Everyday Surgical Practice
	The Surgeon-Patient Relationship: Built Upon Trust
		Introduction
		Trust
			Trust in Medicine
			System Trust
				Physician Trust in the Patient
				Recent Trends in Trust and  the Medical Profession
				Special Aspects of Trust in Surgery
		The Role of Communication
			More than Words
				Teaching Communication Skills
		The Conclusion
		References
	The Transformation and Challenges of the Surgeon–Patient Relationship
		Introduction
		The Surgeon–Patient Relationship Is Unique
		The Doctor–Patient Relationship: A Historical Perspective
		The Surgeon–Patient Relationship: Legal Grounding
		The Surgeon–Patient Relationship: Bioethical Underpinnings
		The Principle of Autonomy in the Surgeon–Patient Relationship
		The Principle of Justice in the Surgeon–Patient Relationship
		The Surgeon–Patient Relationship: Other Conflicts of Interests and Obligations
		The Surgeon–Patient Relationship: Emerging Challenges
		The Surgeon–Patient Relationship: Ethics in Practice
		References
		Suggested Readings
	The Surgical Decision-Making Process: Different Ethical Approaches
		Decision Aids/Decision Support
		Emergency Patients
		Acute, Not Yet Emergent Patients
		Elective Patients
		Surgical Buy-In
		Surgical Candidacy and Moral Agency
		Surgeon as Mere Technician
		Pediatric Patients
		References
	The Surgical Informed Consent Process: Myth or Reality?
		The Informed Consent
		The Components of Informed Consent
		Preconditions
		Information Provided to the Patient
			Physician Disclosure
			Patient Understanding
			Patient Decision-Making
				Consent
		Concluding Remarks
		References
	Informed Consent and Disclosure of Surgeon Experience
		Informed Consent
		Informing the Patient
		Obtaining Consent
		Challenges in Informed Consent
		Assessment of Competence
		Disclosure of Surgeon Experience
		Forecasting
		Concluding Remarks
		Glossary
		References
		Suggested Literature
	The Pediatric Patient as a Self-Individual and Decision-Maker
		The Complexity of the Medical Decision-Making
		Health in the Pediatric Universe
		The Ethical and Legal Status of the Minor
		The Informed Consent Process in Pediatrics
		Conclusions
		Concluding Remarks
		References
		Suggested Literature
	End of Life Issues
		Beneficence
		Non-maleficence
		Respect for Autonomy
		Justice
		Fidelity
		Concluding Remarks
		References
		Suggested Literature and Resources
	Ethics and Surgical Innovation
		Introduction
		Innovation in Surgery
		What Constitutes Surgical Innovation in Terms of Procedure/Technique?
		Oversight of Innovation
		Informed Consent
		Device Development
		Tracking Outcomes
		Training and Credentialing in New Technologies
		Working with Industry
		Disclosures
		Conclusions
		References
	Ethics and Breast Cancer
		Information and Consent: Disclosure
		Breast Conservation vs Mastectomy
		Genetic Testing and Implications: Prophylactic Surgery
		Access to Treatment in Resource Constrained Environments: Compliance with Guidelines
		Ductal Carcinoma In Situ
		Final Remarks
		References
	Ethical Issues in Pediatric Liver Transplantation
		Introduction
			Pediatric Liver Transplant
		Conclusions
		References
		Suggested Bibliography
	Ethical Issues in Cardiothoracic Surgery
		Introduction
		Ethical Frameworks
		Limitations on Care, Withdrawal of Life-Sustaining Care, and Futile Care
		Surgical Outcomes Databases
		Innovation
		Ethics in Cardiothoracic Surgical Education
		Professionalism
		End-of-Life Care
		Conclusions
		References
	Ethics of Surgical Intervention in Jehovah’s Witness Patients
		Introduction
		Historical Background and Transfusion Beliefs of Jehovah’s Witnesses
		Moral Framework
		Beneficence
		Autonomy
		Nonmaleficence
		Justice
		Concluding Remarks
		References
	Ethical Issues in Bariatric Surgery
		Introduction
		Medicalization of Obesity
		Discrimination and Prejudices
		Information and Bariatric Surgery
		Access to Bariatric Surgery
		Psychosocial Assessment and Preoperative Weight Lost
		Centers for Bariatric Surgery and Medical Education
		New Procedures in Bariatric Surgery
		Bariatric Surgery in Children and Teenagers
		Medical Tourism and Bariatric Surgery
		Body Contouring Surgery After Bariatric Surgery
		Should We Deny Surgery for Benign Disorders to Patients with Obesity?
		Conclusion
		Bibliography
	How to Solve Ethical Conflicts in Everyday Surgical Practice: A Toolbox
		Introduction
		Case Presentation
		Preparing to Address an Ethical Dilemma
			The Gathering of Information
			Development and Framing of the Ethical Question
		Models for Analysis
			Beauchamp and Childress “Four Principles”
				Autonomy
				Beneficence
				Non-maleficence
				Justice
				Case Application
			Four-Box Model
				Medical Indications
				Preferences of Patients
				Quality of Life
				Contextual Features
			Pellegrino Approach
		Conclusion
		References
Afterword
Index