Introduction
Ethics and surgical intervention must go hand
in hand. In any other arena of public or private life, if someone deliberately
cuts another person, draws blood, causes pain, leaves scars and disrupts
everyday activity then the likely result will be a criminal charge. If the
person dies as a result, the charge could be manslaughter or even murder. Of
course, it will be correctly argued that the difference between the criminal and
the surgeon is that the latter causes harm only incidentally. The surgeon’s
intent is to cure or manage illness and any bodily invasion that occurs only
does so with the permission of the patient.
Patients
consent to surgery because they trust their surgeons. Yet what should such
consent entail in practice and what should surgeons do when patients need help
but are unable or unwilling to agree to it? When patients do consent to
treatment, surgeons wield enormous power over them —the power not just to cure
but to maim, disable and kill. How should such power be regulated to reinforce
the trust of patients and to ensure that surgeons practise to an acceptable
professional standard? Are there circumstances where it is acceptable to
sacrifice the trust of individual patients in the public interest through
revealing information that was communicated in what patients believed to be
conditions of strict privacy?
These
questions about what constitutes good professional practice concern ethics
rather than surgical technique. Surgeons may be expert in the management of
specific diseases and yet have little understanding of how much and what sort of
information is required for patients to give valid consent to treatment.
Surgeons can understand the delicate techniques associated with specific types
of procedures without knowing when these should be administered to patients who
are unable to consent at all. Surgeons can recognise their own mistakes and
those of colleagues without knowing how much should be said about them to
others. And so it goes on.
Traditional
surgical training offers little help in the resolution of such ethical
dilemmas. This chapter provides guidance which is morally coherent, widely
endorsed and legally justifiable. Our focus will be the practice of surgery
within the United Kingdom, although much of the analysis will also apply to
surgical work elsewhere.