Professional Documents
Culture Documents
SDLS 2008 Moral Aspects of Surgery
SDLS 2008 Moral Aspects of Surgery
Detoxicol
SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: November 11, 2005
Topic: Moral Aspects of Surgery Transcriber(s): Jaime Aherrera
Lecturer: Dr. Renato Ocampo No. of pages: 6
INTRODUCTION
• It is important to understand Informed Consent, especially in Surgery
• FOUR MAIN PRINCIPLES OF TRADIOTIONAL ETHICS
o Stewardship
o Totality **Stewardship & Totality are concerned with Surgery
o Double Effect
o Cooperation
I. STEWARDSHIP
• Humans beings are Custodians of their Own Lives and of the World – We should always take care of our own
body (anything we do to destroy our bodies is Morally Wrong or Immoral)
• Genesis 1:25 – “Go for and Multiply” = we are the Stewards of our lives
• Humans are the Proprietor of everything in this world starting with our bodies
• Informed Consent is NEEDED in the Principle of Stewardship
A. Personal Dimension
o We are the Custodians of ourselves
o We are supposed to take care of the body given to us
o DONT harm the Human Body (don’t smoke, drugs, etc)
B. Social Dimension
o We are supposed to provide the well-being of our patients
o Stewardship extends to other Human Beings – we should also take care of the Well-Being of others
C. Biomedical Dimension
o We are the Stewards of our Patients and Everyone in the Health Service Community
o Health Providers = Prioritize HEALTH and NOT the Wealth of the Patient
D. Ecological
o We are Custodians of the Environment - We must preserve God’s Creations (includes Natural Envrionment)
II. TOTALITY
• In the Human Person, the Parts exist for the Whole; and therefore; the Good of the Part is Subordinated to
the Good of the Whole
• Ex) The eyes are there because they help the Human Body – they are for the good of the whole
I. DEFINITION OF TERMS:
A. Mutilation
o It is the Act of depriving a Limb, a Member or Important Part, Deprival of an Organ
o “Mutilare” – Maim or Distort, Amputate, Diminish or Lessen
o In General, Mutilation is UNACCEPTABLE HOWEVER, Stewardship & Totality Justify Mutilation
o Ex) Removal of a Limb, or even a Small Mole
B. Surgery
o Entails a Positive Invasion of the Body’s Integrity
o There is a Physical Evil = because there is an act of Injury
o Is there a Moral Evil?
o When we Break into the Integrity of the Human Body, there must be an ETHICAL Justification
o Informed Consent is still IMPORTANT
C. Elective Surgery
o The Operation of Procedure is performed on a Non-Urgent Basis
o The Situation DOES NOT pose an Immediate Danger – NOT Life Threatening
3. Even if the other Organs that are affected by the removal are rendered Functionless Secondary to
a more Important Surger
Part of the treatment of Breast Cancer is Ovarectomy (they become Functionless)
Ex) Removal of Ovaries is an Adjunct for Treatment of Cancer
SDLS 2008
2
**Issue on Circumcision:
• If it is done as Routine Procedure by a Hospital, then it is WRONG!
• There is no actual medical need for it at Birth, it is more of a Cultural Thing
A. IMPORTANT Notes:
o Since it is a Necessary Surgery, because it is Curative, then it SHOULD be Done
o Informed Consent is Necessary
1. Comprehensive of Information
We must give all information to the patient
Options, treatment, side effects, etc
2. Effective Reasoning
The Decision comes from a Competent Patient (ability to come up or reach a decision based on the
Relative Issue – Patient should be competent)
It is not necessarily common sense
3. Reflective Deliberation
Patient should be Competent
4. Voluntariness
There should be NO Coercion
Unethical = “If you don’t take this surgery, you will die!”
A. IMPORTANT Notes:
o Since it is NOT designed to Prolong Life but make the patient more Comfortable (the Condition cannot be
cured), it is an OPTIONAL Surgery
o Informed Consent is Necessary
o If proper disclosure of information has been made and the patient still requests it, it may be done but always
weighing the Benefits and the Risks
B. Examples:
1. In a Colon Cancer Patient
There is usually an Obstruction in the Colon – Increasing the chances of Death
Will I remove the Obstruction? Depends on the patient
2. Metastasis
(+) Metastasis to Liver and Lungs (Stage-4) – CANNOT be cured anymore!
Option = Excise the Tumor to relieve the Abdomen’s Distention – however, it is NOT a Cure. It is
only a Relief of the Symptoms
SDLS 2008
3
D. If Proper Disclosure of Information has been made and Patient Still Requests it, It may be done:
o ALWAYS weight the Benefits and Risks
o Ask Patient what he wants, provided that proper Disclosure of Information was done
o Palliative Surgery should NOT be Done to Poor Risk Patients
o This is Exclusive to Patients with End-Stage Diseases
V. UNNECESSARY SURGERY
• It is UNETHICAL to Perform Surgery with no real Medical Indication but which might be Undertaken for
some unworthy Motive such as financial gain or face-saving
• A Surgeon is culpable when, because of Inability of Lack of Knowledge to preserve or repair an Injury, performs an
Amputation / Mutilation rather than ask for assistance or make a referral (Surgery becomes Unnecessary /
Unethical if the Surgeon was NOT Trained to do the Surgery – not qualified)
• Although it would be easier to Amputate, the Surgeon is Bound to Conserve as much as possible part or all of a part
of the Body that is Injured
B. Examples:
1. A Patient with a Skin Tag want to go Overseas – he is required to have Surgery for the Skin Tag
There is NO Medical Indication for the Removal of the Skin Tag – it is actually not needed
It is an Unnecessary Surgery – not really needed
B. Clinical Cases
1. Incidental Appendectomy
Incidental Surgery is when, during the Major Surgical Procedure, the Surgeon decides to remove
the Appendix – although the Appendix is Normal, so as to prevent Future Appendicitis
3. Elective Tonsillectomy
SDLS 2008
4
This is Acceptable in Patients with Chronic Tonsilitis
A. Reconstructive Surgery
o It is a Surgery, Plastic in a Sense and Reconstructive
o It enhances / restores the Anatomic Integrity of Patients who have other Injuries (ex. Trauma, Burns)
o With Extensive Malignancies where you “Chop Off” the Significant Portions of the Body and left a very Huge
Defect (the Defect is Closed and do some Reconstruction)
o There are NO Problems in Strictly Reconstructive Procedures because it is part of the Therapeutic
Management
B. Cosmetic Surgery
o There must be due Proportion between the Risk and Benefits
o These are Procedures that DO NOT have Medical Benefits (Ex. Face Lifts)
A. Patient has a RIGHT to Know and Select the Surgeon to whom he is to Entrust his Life
B. The Moral Evil is the Attendant in Justice which is Likely to Befall the Patient
o Justice = giving someone what is due
o When the patient seeks for your service and there is an Implied Physician-Patient Contract that you are
going to treat him and that he is going to pay – that’s the REALITY!
C. Professional Fee
o The Referring Surgeon has NO Right to it
o The “Ghost Surgeon” has NO Total Right to it because he is an Accomplice
o As a Moral Guideline = even if you are the Attending Surgeon, if you are NOT the one who did the
Procedure, you have NO right to the Professional Fee
SDLS 2008
5
D. The “Ghost Surgeon” is Likely to be Excluded from the Pre-Operative Examination & Post-Operative
Care
o This is Likely to be Detrimental to the Patient
o There is a Lapse in the Total Care because there is NO Continuity in the Preoperative, Operative, and Post-
Operative Care
**The Surgeon’s Obligation to the Patient Requires him to Perform the Operation:
o Within the Scope of Authority Granted by the Consent to Operation
o In accordance with the Terms of the Contractual Relationship
o With Complete Disclosure of Facts, relevant to the Need and the Performance of the Operation
o Utilizing his Best Skills
X. SEXUAL RE-ASSIGNMENT
A. Hermaphrodism
o Also known as Ambiguous Genitalia = meaning, there is some Genetic Problem (Confusion as to the Sex
arises)
o Remember that the Penis is the Homologue of the Clitoris; and the Scrotal Sac is the Homologue of the
Labia Minora – any change may bring about the Confusion
1. Medical & Scientific Tests should be Done to Determine which is the Predominant Determined Sex:
External Genital Morphology
Internal Genital Morphology
Chromosomal Sex
Gender Role
B. Sex-Change
o Sex Change is AGAINST the Law of Nature – if you are created to be a Man, then DON’T insist that you
are a Woman Locked up in a Man’s Body
o The Problem is NOT Physical but EXISTENTIAL
o It is a Total Disregard to the Principal of Stewardship because you are the Guardian of Yourself and you are
Morally Obliged to Preserve your Well-Being and NOT to Destroy what was given to you by Nature
------------------------------------------------------END OF TRANX------------------------------------------------------
SDLS 2008
6