The Ethics of Surgical Practice Cases, Dilemmas, and Resolutions

by Jones, James W.; McCullough, Laurence B.; Richman, Bruce W.

• ISBN13: 9780195321098
• ISBN10: 019532109X
• Edition: 1st
• Format: Paperback
• Copyright: 2008-06-23
• Publisher: Oxford University Press

Summary

Surgical ethics is the application of ethics to issues specific to surgery. This volume provides a collection of clinical case studies representing a wide range of the ethical issues surgeons confront today. It is an excellent text for teaching surgical ethics to surgical residents and medical students and a fascinating read for practicing surgeons. It is intended to engage the reader into participating in evidence-based ethical conflicts. The authors escort us through 71 brief, realistic, and ethically complex problems, offering a series of five possible resolutions to each and guiding us through the relative benefits and weaknesses of the options until a best ethical choice is defended. The volume includes sections on Consent and Disclosure, Self-Regulation, Research and Innovation, Conflicts of Interest, Business Dealings, and End of Life Issues, each with a brief introduction by the authors.

Author Biography

James W. Jones, M.D., Ph.D., M.H.A. is Visiting Professor of Medicine and Medical Ethics at the Center for Medical Ethics and Health Policy at the Baylor College of Medicine in Houston, Texas Laurence B. McCullough, Ph.D, is Professor of Medicine and Medical Ethics in the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston, Texas, and the Center's Associate Director of Education. He is also Adjunct Professor of Philosophy at Rice University in Houston and Adjunct Professor of Ethics in Obstetrics and Gynecology at Weill Medical College of Cornell University in New York City

Table of Contents

Introduction: A Primer on Surgical Ethics	p. 3
Informed Consent and Disclosure	p. 12
Painted Into a Corner: Unexpected Complications in Treating a Jehovah's Witness	p. 17
A Patient Refuses Consent for Life-Saving Surgery	p. 24
Consent for an Intraoperative Video Recording	p. 26
Disclosure of Intraoperative Error	p. 29
The Public's Right to Know? Surgical Treatment of Public Figures	p. 32
Religiously Based Emergency Treatment Refusal	p. 35
Consent for Residents to Perform Surgery	p. 37
The Shifting Sands of Senility: Canceled Consent	p. 40
A Surgeon's Obligation to a Jehovah's Witness Child	p. 44
Are Ethics Practical When Externals Impact Your Clinical Judgment?	p. 47
Professional Self-Regulation	p. 52
What To Tell Patients Harmed By Other Physicians	p. 55
The Military Physician's Ethical Response to Evidence of Torture	p. 59
Who Should Protect the Public Against Bad Doctors?	p. 64
Disagreements Between Attending and Consultant Physicians	p. 71
Turf Wars: The Ethics of Professional Territorialism	p. 74
Eyewitness to Incompetent Surgery	p. 80
Ethics of Operative Scheduling: Balancing Multiple Fiduciary Responsibilities	p. 82
Do Unto Others: Justice in Surgical Education	p. 85
The Surgeon's Obligations to the Noncompliant Patient	p. 88
The Ethics of Serving as a Plaintiff's Expert Medical Witness	p. 92
Standard of Care: What Does It Really Mean?	p. 96
Innovation and Research	p. 101
When does Conventional Surgical Therapy Become Research?	p. 106
A Surgeon's Obligations When Performing New Procedures	p. 108
The Ethics of Innovative Surgical Approaches for Well-Established Procedures	p. 111
Using Surgical Innovation to Treat Rare Diseases	p. 116
Ethics of Introducing New Operating Room Technology	p. 120
Patenting Surgical Procedures	p. 124
Sham Surgery in Research	p. 127
Stem Cell Research: Obligations When Religious Values Conflict with Professional Values	p. 130
Ethics of Odd Ideas, Good Science, and Academic Freedom	p. 135
The Ethics of By-Lines: Would the Real Authors Please Stand Up?	p. 140
When the Data Won't Get You There: The Ethics of Scientific Error, and Worse	p. 145
Conflicts of Interest and Conflicts of Commitment	p. 150
Intentional Overtreatment: The Unmentionable Conflict of Interest	p. 152
Patient Responsibilities, Family Responsibilities	p. 157
Nonfinancial Conflicts of Interest	p. 160
Ethics of Overscheduling: When Enough Becomes Too Much	p. 163
An Impaired Surgeon and Supervisory Responsibilities	p. 167
Surgeon-Industry Relationships: Ethically Responsible Management of Conflicts of Interest	p. 170
Relationship Funding of Professional Foundations: Just a New Black Sheep?	p. 173
When to Refer to Another Surgeon	p. 178
HIV Infection, Professional Responsibility, and Self-Interest	p. 180
Ethics of Combining Romance with Medical Practice	p. 183
Ethics of Operating on a Family Member	p. 187
The Ethics of Surgery as a Business	p. 192
Show Me the Money: The Ethics of Physicians' Income	p. 195
Ethics of Institutional Marketing: The Role of Physicians	p. 201
Ethics of Boutique Medical Practice	p. 204
Ethics and Commercial Insurance	p. 208
Ethics of Clinical Pathways and Cost Control	p. 212
Ethics of Professional Courtesy	p. 216
Ethics of Administrative Credentialing	p. 219
Ethics of the New Economic Credentialing: Conflicted Leadership Roles	p. 224
Whodunit? Ghost Surgery and Ethical Billing	p. 229
Other People's Money: Ethics, Finances, and Bad Outcomes	p. 235
Consultation or Corruption? The Ethics of Signing on to the Medical-Industrial Complex	p. 240
Challenges to Medical Professionalism: Assaults from Within and Without	p. 247
Going Public with Amazing Cases: Fiat or Fiasco?	p. 250
Ethics of Unprofessional Behavior That Disrupts: Crossing the Line	p. 254
My Brother's Keeper: The Ethics of Uncompensated Care for Illegal Immigrants	p. 258
From Premiums to Payouts: Who's Behind the Professional Liability Crisis, Anyway?	p. 265
A Helping Hand Bitten: An Ethical Response to Medical Malpractice Suits	p. 273
Case-Load Outcome Credentialing: Taking from the Have-Nots	p. 280
Fiduciary Economization: Your Wealth or Your Health	p. 285
What to Do When a Patient's International Medical Care Goes South	p. 290
End-of-Life Issues	p. 295
Futility and Surgical Intervention	p. 301
Complying with Advance Directives in the Operating Room	p. 303
Abdominal Aortic Aneurysm in a Death Row Inmate	p. 305
Telling the Truth About Terminal Diseases	p. 308
Arsenic and Old Lace: End-of-Life Care in the Postoperative Period	p. 312
Training on Newly Deceased Patients	p. 315
Advanced Age, Dementia, and an Abdominal Aneurysm: Intervene?	p. 318
Withdrawal of Life-Sustaining Low-Burden Care	p. 322
Physician-Assisted Suicide: Has It Come of Age?	p. 326
Index	p. 331
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