The History of Surgical Ethics

Abstract

The origin of surgical ethics has been ambiguous. Some claim it dates back to the ancient Greeks, but most believe it began at least in part with Gregory and Percival who are credited as the founders of modern medical ethics. Although medical and surgical ethics share common fundamental principles, surgical ethics evolved distinctly from medical ethics due to the unique nature of surgery and the surgeon-patient relationship. The history of surgery as a profession has revolved around ethical issues unique to surgery such as fee splitting, itinerant surgery, informed consent, solid organ transplantation, and surgical innovation. As the field of surgery continues to advance, society will rely on surgeons to guide the future of surgical ethics to ensure that trust is upheld and the focus remains on the patient.

Glossary

Nonmaleficence

A fundamental principle of bioethics meaning first do no harm. It is based from the writings of Hippocrates primum non nocere.

Fee splitting

The practice of splitting the price the patient paid for surgery. It incentivized both the referring physician and the surgeon. It was addressed when ACS was first established as an unethical practice.

Itinerant surgery

A common practice in the early twentieth century when a surgeon would come at the request of a primary care physician and perform a surgery without ever seeing the patient first. Postoperative care was also left in the hands of the primary care physician. It was addressed as unethical practice, and surgeons were barred entrance into ACS fellowship if they were known to do this practice.

Reasonable person standard

Referring to the disclosure that accompanies the informed consent discussion. The reasonable person is the accepted form of disclosure meaning that the information disclosed should be in line with a hypothetical reasonable person.

Justice

One of the fundamental principles of bioethics. It is based on the idea fairness and equal treatment for all involved parties.