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.