ETHICS IN SURGICAL PRACTICE

OUTLINE

• Introduction

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• Principles of ethics in surgical practice

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• Components of ethical surgical practice

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• Conclusion

INTRODUCTION

• “Ethics” derived from the Greek word “ethos” which means character

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• It is the aspect of surgery that defines what is good for individual patients and the society as a whole and establishes the nature of obligations and duties that the surgeon owes the patients, his/her colleagues and himself/herself

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• Origin: 4^th century BC when Greek physicians drafted the Hippocratic oath,this has been passed on to generatons,as the times dictate.

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• It outlines the surgeon’s best understanding of moral principles

• The core of surgical ethics:
• The Surgeon-Patient relatonship
• The Surgeon’s responsibility to advance and protect the well being of the patient

PRINCIPLES OF ETHICS IN SURGICAL PRACTICE

• Evolves to reflect present situation of clinical experience

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• Emphasizes the need for shared decision-making (the surgeon should not make unilateral decisions on patient management but must respect the patient’s views)

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• Investigates and dictates what should be the surgeon’s conduct and character while rendering service

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COMPONENTS OF ETHICAL SURGICAL PRACTICE

This is called the 4 pillars of biomedical ethics/Belmont’s principles;

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• Autonomy

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• Beneficence

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• Non-maleficence

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• Justice

COMPONENTS OF ETHICAL SURGICAL PRACTICE…

AUTONOMY

• Insists that patient has autonomy of thought, intention and action when making decisions regarding healthcare procedures and interventions

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• Decision making process must be free of coercion or coaxing

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• Lays emphasis on informed consent, shared decision-making and confidentiality regarding shared information

PROCESS OF INFORMED CONSENT

• Explain these to the patient: patient’s disease, untreated natural history, recommended treatment, risks and benefits of this treatment, anticipated outcome/prognosis, alternative treatments

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• Be sure the patient understands the above explanation

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• Allow the patient time to think over the above information (and possibly consult other stakeholders or do their own research)

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• Get feedback from the patient (which could be consent or dissent)

COMPONENTS OF ETHICAL SURGICAL PRACTICE…

BENEFICENCE

• States that all procedures should be performed with the intent of doing good for the patient involved

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• Demands that all healthcare providers develop and maintain skills and knowledge and continually update training

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• Considers individual circumstances of all patients and strives for net benefit amongst all patients

COMPONENTS OF ETHICAL SURGICAL PRACTICE…

NON-MALEFICENCE

• Emphasizes the doctrine of “primum non nocere” meaning “first do no harm”

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• Requires that a procedure does not harm the patient involved or others in the society

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• Weighs the benefit of the procedure against the potential harm involved before making a decision on whether or not to proceed with the procedure

COMPONENTS OF ETHICAL SURGICAL PRACTICE…

JUSTICE

• Stresses the point that the burdens and benefits of treatment as well as access to treatment must be distributed equally among all patients

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• Discourages favouritism in care for patients

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• Also emphasizes that the surgeon should maintain good standards of care while attending to individual patients

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• Encourages honesty while discouraging negligence and malpractice

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HISTORICAL BASIS

• Ethics in surgery has been as old as surgery itself.
• Sushruta and other ancient Indian texts have described the expected norms of Physicians
• The American college of Surgeons,first in 1913
• The Australasian Surgeons in 1933

• Sushruta grouped surgical ethics into;
• General ethics
• Professional and academic ethics
• Pre,per & post op ethics
• Ethics in research or experimental surgery
• Professional code of conduct

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• Egyptian and Hammurabi’s medical texts had their writthen codes of conduct
• Surgical ethics has evolved into a specialty concerned with ethical issues relating to being a Surgeon.

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PROFESSIONALISM &ETHICS

• Professional competence is the habitual and judicious use of knowledge,technical skills,clean reasoning,emotions,values and reflections in daily practice for the benefit of the individual and the community being served

THE QUALITIES OF A TRUE PROFESSIONAL

• Strong and appropriate clinical competence
• Altruistic in nature(placing patient’s benefit first)
• Good communication skills
• Commitment to quality and excellence
• Sound understanding of ethics,is accountable&humane
• Accepts fiduciary(trustee,guardian) obligations
• Responsive to societal needs empathy

• Has ablility to deal with ambiquity and complexity
• Open to criticism and understands limitations
• Punctuality
• Well organized
• Professional appearance with good hygiene
• Modesty and humility
• Courteous

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• Has a positive attitude and focused
• Pursues continuous improvement or a lifelong learner

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Most medical councils and Professional Specialties in Medicine/Surgery have modified these to suit their needs

CONCLUSION

• The basic concept in surgical practice is that the surgeon adheres to the principle of undertaking possible actions to treat the patient while maintaining very high moral standards
• These standards are regulated by the application of the components of ethics in surgical practice
• Failure to adhere to these components often results in disastrous consequences especially for the surgeon