Ethical Issues in Cardiothoracic Surgery
The field of cardiothoracic surgery shares many moral principles and related ethical challenges with other branches of surgery but must deal with them in contexts unique to the specialty. Ethical issues that are currently under active discussion and debate in the cardiothoracic surgical community include professionalism; the need to balance the multiple professional responsibilities such as duty to patient, duty to employer, and duties to trainees; the use, and potential misuse, of national quality databases; the oversight of innovation; and futile, end-of-life, and withdrawal of care. Such issues will be reviewed in the context of both duty-based and consequentialist ethical frameworks.
KeywordsEthics Bioethics Professionalism Innovation End-of-life care Surgical outcomes Databases
- 2.Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2013. p. 13.Google Scholar
- 3.Ferreres AR, Angelos P, Singer EA, editors. Ethical issues in surgical care. Chicago: American College of Surgeons; 2017.Google Scholar
- 4.Sade RM, editor. The ethics of surgery. New York: Oxford University Press; 2015.Google Scholar
- 6.Chaet DH. The AMA Code of Medical Ethics’ opinions on patient decision-making capacity and competence and surrogate decision making. AMA J Ethics. 2016;18(6):601–3. https://doi.org/10.1001/journalofethics.2016.18.6.coet1-1606.CrossRefGoogle Scholar
- 8.Brock D. Chapter 9: Utilitarianism. In: Regan T, VanDeVeer D, editors. And justice for all: new introductory essays in ethics & public policy. Totowa: Rowman and Littlefield; 1982.Google Scholar
- 9.Beauchamps TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2013. p. 226.Google Scholar
- 16.Cornwell LD, Omer S, Rosengart T, et al. Changes over time in risk profiles of patients who undergo coronary artery bypass graft surgery: the veterans affairs surgical quality improvement program (VASQIP). JAMA Surg. 2015;150(4):308–15. https://doi.org/10.1001/jamasurg.2014.1700.CrossRefPubMedGoogle Scholar
- 17.Seder CW, Wright CD, Chang AC, Han JM, McDonald D, Kozower BD. The society of thoracic surgeons general thoracic surgery database update on outcomes and quality. Ann Thorac Surg. 2016;101(5):1646–54. https://doi.org/10.1016/j.athoracsur.2016.02.099. Epub 2016 Mar 31. PMID: 27041451.CrossRefPubMedGoogle Scholar
- 21.Courtwright AM, Robinson EM, Feins K, Carr-Loveland J, Donahue V, Roy N, McCannon J. Ethics Committee Consultation and Extracorporeal Membrane Oxygenation. Ann Am Thorac Soc. 2016;13(9):1553–8. https://doi.org/10.1513/AnnalsATS.201511-757OC. PMID: 27299991.
- 25.Freidson E. Chapter 12: Nourishing professionalism. In: Professionalism reborn: theory, prophecy, and policy. Chicago: University of Chicago Press; 1994.Google Scholar
- 26.Aviv R. What does it mean to die? New Yorker Magazine. 2018, February 5, Issue. https://www.newyorker.com/magazine/2018/02/05/what-does-it-mean-to-die.