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Surgical Ethics: Relationships with Patients, the Profession, and Society

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Relationships with Patients, the Profession, and ... Confidentiality Conflict of Interest Surgical Competence End of Life Truth Telling Resource Allocation ... – PowerPoint PPT presentation

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Title: Surgical Ethics: Relationships with Patients, the Profession, and Society


1
Surgical EthicsRelationships with Patients,the
Profession, and Society
  • Martin McKneallyUniversity of TorontoDept. of
    Surgery Joint Centre for Bioethics
  • Principles of Surgery
  • October 5, 2010

2
  • Dr. McKneally, this is Jerry Wilson of the FBI.
    Can you answer some questions for me?
  • What kind of ethics education or training is
    given to surgeons?
  • The Moon/Realyvasquez case

3
Doctors accused of performing unnecessary heart
surgeries at Redding Medical Center agree to pay
millions to settle fraud allegations and accept
restrictions on their medical practice
  • U.S. Department of Justice, 2005

4
Plan of talk
  • Whats an Ethic?
  • Teaching Ethics
  • The Ethic of Surgery
  • Obligations
  • to patients
  • to the team
  • to society

5
Ethics.Whats an Ethic?
  • A set of values, principles, and beliefs,
    standards of conduct
  • Guides the behaviour of a specified group
    journalists, lawyers, mafiosi, monks, physicians,
    surgeons.
  • What we should do codes of conduct

6
Ethics
should
Policy
Law
usually
must
7
Ethics
censure
Policy
Law
disapproval
fines/prison
8
Contemplation before surgery Joe Wilder, MD
9
Thou Shalt Teach Bioethics
  • RCPSC 1995

10
Ethical Issues Taught FormallyConsent,
end-of-life, disclosure, surgical competence,
surgical decision-making, COI, resource
allocation, research/innovation
  • Ethical Challenges Not in Formal Curriculum
  • Intra- and inter-professional conflict, lack of
    experience, training issues, perceived unethical
    staff behaviour

11
Ethic of Surgery
  • Trustworthiness
  • Competence
  • Commitment

12
Trustworthiness
  • We are trusted to live up to our obligations
  • Professional competence, commitment
  • Fiduciary what is best for the patient
  • Team integrity, coworker care
  • Societal community need for surgical care

13
Surgical Competence
  • Knowledge - timely and appropriate
  • Judgment - balanced
  • - attentive to the particular needs and
    circumstances of the individual patient
  • - the right operation for the right
    patient at the right time
  • Technical Skill - sufficient to perform the
    surgical intervention
  • - minimum of risk
  • - high probability of benefit

14
Commitment
Personal responsibility uniquely
intensified Constancy warrior energy
15
Fiduciary Obligation
  • Put patients interests above all others,
    including the physicians
  • Trustworthy care
  • competence, commitment
  • Respect
  • dignitary rights
  • privacy, confidentiality

16
Confidentiality
  • Patients and the profession expect physicians not
    to disclose private information learned in the
    course of care

17
Team Obligations
  • Maintaining the integrity of the team
  • Coworker care attention to the needs and
    concerns of team members

18
(No Transcript)
19
Societal Obligations
  • Implicit contract with society
  • Duty to treat
  • Explicit contract
  • with individual patient
  • emergency care
  • public agencies
  • Challenges AIDS, SARS, Avian flu,
  • COI, hypocompetent surgical care

20
Societal Obligations of Surgeons
  • Effective subsystems of care
  • Trauma system
  • Cardiac Care Network
  • Cancer Care Ontario
  • CritiCall

21
Societal Obligations of Surgeons
  • Developing subsystems
  • Coaching teams
  • Critical care Tom Stewart
  • General surgery Ori Rotstein, Andy Smith,
    Bernie Langer
  • Orthopaedics Alan Gross

Coach Alan Hudson
22
Summary Ethic of Surgery
  • Trustworthiness
  • Competence
  • Commitment
  • Obligations
  • Patients
  • Team
  • Society

23
(No Transcript)
24
  • martin.mckneally_at_utoronto.ca
  • Office 416-978-8909

25
(No Transcript)
26
Ethical Issues Taught FormallyConsent,
end-of-life, disclosure, surgical competence,
surgical decision-making, COI, resource
allocation, research/innovation
  • Ethical Challenges Not in Formal Curriculum
  • Intra- and inter-professional conflict, lack of
    experience, training issues, perceived unethical
    staff behaviour

27
RCPSC Bioethics Curriculum Surgery
  • Consent
  • Capacity, Disclosure, Surrogates
  • Professional Conduct
  • Duty to treat, Confidentiality
  • Conflict of Interest
  • Surgical Competence
  • End of Life
  • Truth Telling
  • Resource Allocation
  • Research Ethics

28
Circumstance Culture Religion Politics
Ethics
should
Policy
Law
must
usually
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