How to Solve Ethical Conflicts in Everyday Surgical Practice: A Toolbox

  • Darren S. Bryan
  • Peter AngelosEmail author


In the practice of medicine and surgery, ethically challenging issues frequently arise. Surgeons practice within a medical realm that is deeply dependent upon a meaningful physician-patient relationship, with an ethos dually emphasizing patient self-determination and physician guidance. Surgeons are likely familiar with the navigation of ethical conundrums, however frequently do so without formal training. While historically the purview of theologians and philosophers, the field of clinical medical ethics has evolved significantly since its inception in the 1970s, helping clinicians to practically address commonly encountered issues. With this chapter, we aim to provide the practicing surgeon with a toolkit to assist in formulating ethical questions and addressing them in a systematic fashion. First, we present a fictional patient scenario with several ethical issues commonly encountered by surgical providers. We then introduce three well-known, published methods for the evaluation of the ethical problem – the Beauchamp and Childress model, the “Four-Topic (or Four-Box)” approach, and the Pellegrino approach – and apply each method to the theoretical case.


Surgical ethics Clinical ethics Medical ethics Four-box model Ethical principlism 


  1. 1.
    Siegler M. A legacy of Osler. Teaching clinical ethics at the bedside. JAMA. 1978;239(10):951–6.CrossRefGoogle Scholar
  2. 2.
    Siegler M. Clinical ethics and clinical medicine. Arch Intern Med. 1979;139(8):914–5.CrossRefGoogle Scholar
  3. 3.
    Siegler M, Pellegrino ED, Singer PA. Clinical medical ethics. J Clin Ethics. 1990;1(1):5.PubMedGoogle Scholar
  4. 4.
    Pellegrino ED. Toward a reconstruction of medical morality. Am J Bioeth. 2006;6(2):65–71.CrossRefGoogle Scholar
  5. 5.
    Lo B. Resolving ethical dilemmas: a guide for clinicians. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. x; 2013, 369 p.Google Scholar
  6. 6.
    Beauchamp TL. Principles of biomedical ethics. Array ed. In: Childress JF, editors. New York: Oxford University Press; 2009.Google Scholar
  7. 7.
    Health, N.I.o., The Belmont Report. Belmont Rep. Ethical Princ. Guidel. Prot. Hum. Subj. Res. 1979. p. 4–6.Google Scholar
  8. 8.
    Brudney D, Lantos J. Agency and authenticity: which value grounds patient choice? Theor Med Bioeth. 2011;32(4):217–27.CrossRefGoogle Scholar
  9. 9.
    Kant I. Groundwork for the metaphysics of morals. 1785.Google Scholar
  10. 10.
    Gillon R. “Primum non nocere” and the principle of non-maleficence. Br Med J (Clin Res Ed). 1985;291(6488):130–1.CrossRefGoogle Scholar
  11. 11.
    Jonsen AR. Clinical ethics a practical approach to ethical decisions in clinical medicine. Array ed. In: Siegler M, Winslade WJ, editors. McGraw-Hill’s AccessMedicine. New York: McGraw Hill Medical; 2015.Google Scholar
  12. 12.
    Sulmasy DP. Edmund Pellegrino’s philosophy and ethics of medicine: an overview. Kennedy Inst Ethics J. 2014;24(2):105–12.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryThe University of ChicagoChicagoUSA
  2. 2.The MacLean Center for Medical EthicsThe University of ChicagoChicagoUSA

Personalised recommendations