Ethical Challenges in the Operating Room

by G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics •

Editor’s note: This is part 1 of 2 on ethics in the operating room. The second installment will be published in the December issue of ENTtoday.

You are the chair of your medical center’s ethics committee and director of the hospital’s ethics consultation service. As an otolaryngologist with a busy surgical practice, you spend a good deal of time in the operating room and understand the special ethical challenges that this patient care center can pose for surgeons and staff. Additionally, you worked recently as the chief of the specialty surgical services.

Your presence is requested for a conference meeting with the hospital’s medical director, chief of surgical services, chief hospital nurse, and head nurse of the operating room. During this meeting, these individuals indicate that they are undertaking an effort to review all of the procedural rules and guidelines for the operating room (OR), including the recent statement by the American College of Surgeons on the responsibility of the primary attending surgeon during surgery. These leaders seek your input and advice regarding ethical considerations that could have a bearing on the revision and/or clarification of the procedural rules and guidelines. They realize that it is important to understand “ethics in the OR” for many of the everyday challenges and dilemmas that arise during the course of performing surgery.

You agree to provide your knowledge and perspectives, and those of other surgeons who participate in the ethics committee’s deliberations, for their consideration. The first set of procedures and rules for the primary attending surgeon that they would like for you to address includes the following:

  • Informing patients, during the consent process, about staff members who will be a functional part of the surgical team, and alerting them to team members’ roles and experience level; and
  • Informing patients clearly and concisely about the process of overlapping, sequenced, and multidisciplinary surgeries under the direction of the primary attending surgeon, and about how this practice might affect their care.

Discussion

Patients are, in general, woefully lacking in information and understanding about who, specifically, is participating in their surgical procedures, and what role each participant will play. It is clearly the responsibility of the primary attending surgeon to clarify these roles to the patient during the surgical informed consent discussion and process. In the Statement of Principles, the American College of Surgeons explains that this responsibility should include “a discussion of the different types of qualified medical providers who will participate in their (patient’s) operation and their respective roles” (available at facs.org/about-acs/statements).