The Ethics of Surgery: Conflicts and Controversies

ISBN : 9780190204532

Robert M. Sade
384 Pages
162 x 241 mm
Pub date
Mar 2015
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According to popular belief, technical skill is far more important for surgeons than thoughtful deliberation. Nothing could be further from the truth. Although surgeons must sometimes make decisions rapidly on the basis of incomplete evidence and must respond to unexpected catastrophes in the operating room rapidly, those events are intermittent - most of the time surgeons deliberate on diagnostic problems and thoughtfully manage postoperative care, which is often intellectually challenging. The relationship of surgeons with their patients is, in a real sense, far more intimate and trusting than that of any other professional, a claim that is supported by the fact that patients surrender their bodies to their surgeons in a state of total helplessness and vulnerability when they undergo anesthesia. Because of that responsibility, no other professional group has a greater sense of dedication to the welfare of their patients than surgeons. Surgical culture is deeply steeped in ethics, and surgeons confront and resolve ethical dilemmas as much or more than most other professionals, although they often may not recognize the situations they resolve are problems in ethics - they are just part of the daily routine. This book is a compendium of articles from the recent surgical literature that address ethical issues chosen by surgeons because they are controversial and pertinent to the practice of surgery. The reader will not find a great deal of sophisticated dissection of fine philosophical distinctions in these discussions of ethical conflicts and controversies in surgery. Instead, they will discover differing viewpoints from thoughtful essayists, mostly surgeons, whose feet are firmly in contact with the ground and who have extensive experience in the real world of surgery, medicine, and law.


Robert M. Sade, MD
Chapter 1: Ethics Gap in Surgery
Robert M. Sade, MD, Timothy H. Williams, MD, David J. Perlman, MA, Cynthia L. Haney, JD, and Martha R. Stroud, MS
Chapter 2: Ethics in Cardiothoracic Surgery: A Survey of Surgeons' Views
Thomas A. D'Amico, MD, Martin F. McKneally, MD, and Robert M. Sade, MD
Chapter 3: Deceiving Insurance Companies: New Expression of an Ancient Tradition
Robert M. Sade, MD
Chapter 4: Hepatitis C Virus-Infected Resident: End of Residency, End of Career?
Carolyn M. Dresler, MD, MPA, Michael S. Kent, MD, Richard I. Whyte, MD, MBA, Robert M. Sade, MD
Chapter 5: Must Surgeons Tell Mitral Valve Repair Candidates About a New Percutaneous Repair Device That Is Only Available Elsewhere?
Eric R. Skipper, MD, Kevin D. Accola, MD, and Robert M. Sade, MD
Chapter 6: The Surgeon's Work in Transition: Should Surgeons Spend More Time Outside the Hospital?
Jamie Dickey, PhD, Ross M. Ungerleider, MD, Joseph S. Coselli, MD, Lori D. Conklin, MD, Robert M. Sade, MD
Chapter 7: Should Sleep-Deprived Surgeons Be Prohibited From Operating Without Patients' Consent?
Charles A. Czeisler, PhD, MD, Carlos A. Pellegrini, MD, and Robert M. Sade, MD
Chapter 8: Are Thoracic Surgeons Ethically Obligated to Serve as Expert Witnesses for the Plaintiff?
Donald C. Watson, Jr, MD, Francis Robicsek, MD, PhD, Robert M. Sade, MD
Chapter 9: Should a Jehovah's Witness Patient Who Faces Imminent Exsanguination Be Transfused?
Keith S. Naunheim, MD, Charles R. Bridges, MD, ScD, and Robert M. Sade, MD
Chapter 10: No Heroic Measures: How Soon Is Too Soon to Stop?
Thomas A. D'Amico, MD, Mark J. Krasna, MD, Diane M. Krasna, CRNA, Robert M. Sade, MD
Chapter 11. Should Surgical Errors Always Be Disclosed to the Patient?
Constantine Mavroudis, MD, Constantine D. Mavroudis, MD, Keith S. Naunheim, MD, and Robert M. Sade, MD
Chapter 12: Another Surgeon's Error: Must You Tell the Patient?
Susan D. Moffatt-Bruce, MD, PhD, Chadrick E. Denlinger, MD, Robert M. Sade, MD
Chapter 13. Impending Loss of Insurance Coverage is an Indication to Proceed With Complex, Expensive Surgery
Anthony L. Estrera, MD , Sharon Ikonomidis, PhD, John S. Ikonomidis, MD, Robert M. Sade, MD
Chapter 14: Ethical Obligation of Surgeons to Noncompliant Patients: Can a Surgeon Refuse to Operate on an Intravenous Drug-Abusing Patient With Recurrent Aortic Valve Prosthesis Infection?
J. Michael DiMaio, MD, Tomas A. Salerno, MD, Ron Bernstein, JD, Katia Araujo, PsyD, Marco Ricci, MD, Robert M. Sade, MD
Chapter 15: Surgical Innovation: Too Risky to Remain Unregulated?
Haavi Morreim, PhD,, Michael J. Mack, MD, Robert M. Sade, MD
Chapter 16: Who Should Adopt Robotic Surgery, and When?
Jessica K. Smyth, MD, Karen E. Deveney, MD, Robert M. Sade, MD
Chapter 17: Should Access to Transcatheter Aortic Valve Replacement Be Limited to High-Volume Surgical Centers?
Joseph E. Bavaria, MD, Philip Green, MD, Gregg F. Rosner, MD, Martin B. Leon, MD, Allan Schwartz, MD, Robert M. Sade, MD
Chapter 18: Should the Use of Transcatheter Aortic Valve Implantation be Rationed?
John E. Mayer, Jr, MD, Grayson H. Wheatley III, MD, Robert M. Sade, MD
Chapter 19: Heart Donation Without the Dead Donor Rule
Franklin G. Miller, PhD, Robert M. Sade, MD
Chapter 20: Saving Lives Is More Important Than Abstract Moral Concerns: Financial Incentives Should Be Used to Increase Organ Donation
Benjamin Hippen, MD, Lainie Friedman Ross, MD, Robert M. Sade, MD
Chapter 21: Prisoners on Death Row Should Be Accepted as Organ Donors
Shu S. Lin, MD, PhD, Lauren Rich, RN, BSN, Jay D. Pal, MD, PhD, Robert M. Sade, MD
Chapter 22: Politely Refuse the Pen and Note Pad: Gifts From Industry to Physicians Harm Patients
Kenneth V. Iserson, MD, MBA, Robert James Cerfolio, MD, Robert M. Sade, MD
Chapter 23: Should the Financial Link Between Industry and Physician Consultants Be Severed?
Stephen J. Immelt, JD, Vincent A. Gaudiani, MD, Robert M. Sade, MD
Chapter 24: Full Disclosure-Should Presentations and Publications Include Dollar Amounts and Duration of Surgeon-Industry Relationships?
J. Peter Murphy, MD and Robert M. Sade, MD
Chapter 25: Medical Ethics Collides With Public Policy: LVAD for a Patient With Leukemia
Patrick M. McCarthy, MD,, Richard D. Lamm, LLB, CPA, Robert M. Sade, MD
Chapter 26: Should Coronary Artery Bypass Grafting Be Regionalized?
Brahmajee K. Nallamothu, MD, MPH, Kim A. Eagle, MD, Victor A. Ferraris, MD, PhD, Robert M. Sade, MD
Chapter 27: A Clash of Rights: Should Smoking Tobacco Products in Public Places be Legally Banned?
Carolyn Dresler, MD, MPA, Mark J. Cherry, PhD, Robert M. Sade, MD
Chapter 28: Should a Medical Center Deny Employment to a Physician Because He Smokes Tobacco Products?
James W. Jones, MD, PhD. MHA, William M. Novick, MD, Robert M. Sade, MD

About the author: 

Robert M. Sade, MD, is Distinguished University Professor, Professor of Cardiothoracic Surgery and Director of the Institute of Human Values in Health Care at the Medical University of South Carolina, where he also is Director of the Clinical Research Ethics Program. At MUSC, he created the Section of Pediatric Cardiac Surgery in 1975 and has concentrated mainly on biomedical ethics for the last two decades. He has written several hundred articles, book chapters, and books on cardiothoracic surgery, medical education, biomedical ethics, and health policy.

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