Ethical Challenges in the Operating Room

A few patients, for one reason or another, are not comfortable with trainees performing parts of their surgical procedure, and the primary attending surgeon must manage this situation with understanding, support, and discussion. It is possible that the patient may have misleading or inaccurate information, believing that a patient is “experimented” on at a teaching hospital. Every effort must be taken to explain the true circumstances surrounding the multiple levels of experience of the surgical team in a teaching hospital, with the oversight and involvement of the primary attending surgeon serving the pivotal role.

However, if a patient continues to refuse to have trainees take part in her/his surgery, and cannot be dissuaded from that decision through education and explanation, then a teaching hospital may not be the best place for the patient to have surgery, and the physician may offer a referral to a community surgeon. No surgeon wants to put a patient in an untenable position; nor should the surgeon be placed in one. Mature professional judgment, based on experience and understanding of the patient’s perspective, can lead to an amicable resolution to this dilemma.

The operating room, like the emergency department and intensive care unit, is a unique clinical setting where patients’ lives are held in the balance, and the balance may depend upon careful planning and preparation and meticulous execution of these plans. Within an operating room, the course of surgery is much like an orchestra performance—each section, each performer has a specific job to do, yet they must all be done in the harmony of safety, placing the patient’s well-being as the most important priority. The operating room is not a “haven” from ethical dilemmas, but rather a focused application that balances of the ethical principles of autonomy, beneficence, nonmaleficence, and social justice.

Part 2 of “Ethics in the Operating Room,” which will be published in the December 2016 issue of ENTtoday, will focus on bedside evaluation skills.

Dr. Holt is professor emeritus in the department of otolaryngology-head and neck surgery at the University of Texas Health Science Center in San Antonio.