Difficult Decisions in Surgical Ethics

Vassyl A. Lonchyna, MD, MJ is a cardiothoracic surgeon and a surgical intensivist, affiliated with The University of Chicago.  He received his medical degree from Wayne State University School of Medicine, his surgical training at Duke University and Loyola University and his surgical critical care training at Stroger Hospital in Chicago. He was a Fellow at the MacLean Center for Medical Ethics, a US Fulbright Scholar in Ukraine, and lectures at the Institute of Bioethics at The Ukrainian Catholic University in Lviv, Ukraine. He has retired after being in practice for more than 40 years.  Peggy Kelley, MD is a practicing pediatric Ear, Nose & Throat (ENT Specialist) in Portland, OR following a 20-year career at Children's Hospital Colorado, University of Colorado. Dr. Kelley graduated from University of Pittsburgh School of Medicine, her otolaryngology training was at the University of Rochester with a fellowship in pediatric otolaryngology at Children's Medical Center in Cincinnati, OH. She served on the Ethics Committee and as an Ethics Consultant at Children’s Colorado and Parker Adventist Hospital and as volunteer faculty at the University of Colorado Center for Bioethics and Humanities. She completed the MacLean Center fellowship supported by the American College of Surgeons Travel Scholarship and led by Dr. Angelos in the same year as Dr. Lonchyna.Peter Angelos, MD, PhD is Professor of Surgery, Chief of Endocrine Surgery, and Associate Director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. He received his undergraduate degree, medical degree, and a doctoral degree in philosophy from Boston University. He has written widely on ethical issues in surgical practice, optimizing endocrine surgical outcomes, and how to best teach medical ethics to surgical residents. He is past president of the American Association of Endocrine Surgeons and Councilor of the American Board of Surgery.

• Preface.- In the Beginning.- Importance of Formal Education in Medical Ethics in the XXIst Century.- What Makes Surgical Ethics Unique?.- Notable Ethical Sugeons.- Communication.- Transparency in Surgery.- Is Informed Consent Truly Informed? And Does It Matter?.- Shared Decision Making. "What would you do in my case, Doctor?".- Obtaining Surgical Consent Under Duress. When Not to Operate?.- Goals of Care Discussions in High Risk Surgery..- When Surgeons and Patients Disagree.- How to Deliver Bad News. A Family Post-mortem.- Surgical Empathy. - Surgical Education.- Teaching Surgical Ethics.- Training Residents: Disclosure to Patients, Communication During Awake Surgery.- Informed Consent of Patients Regarding Trainee Participation.- Can Professionalism be Taught During Residency?.- Autonomy In Residency: the Dual Role of the Academic Surgeon.- Medical Discrepancy/ Medical Error.- Concurrent Operations in Different ORs.- Disclosure of Surgical Errors.- Expert Witness Testifying Against Colleagues.- Cultural / Religious Diversity.- Acceptance of Refusal of Surgery due to Religious or Cultural Reasons.- Is it Inappropriate to use the Word "Death" when obtaining Surgical Consent?.- Bloodless Surgical Strategy for Jehovah's Witness Patients.- Surgery on the Incarcerated Patient.- Surgical Dilemmas in the Adult Patient.- Surgical Buy-in for Major Surgical Procedures.- Ethics of Caeserian Delivery on Maternal Request (CDMR).- Fertility Sparing Surgery Instead of Definitive Cancer Resections.- Ethical Decision-Making in Treatment of Aortic Aneurysms, Elective or Emergent (Ruptured).- Denial of Mechnical Assist Devices/Transplantation Due to Disability, Economics or Social Status.- Surgical Dilemmas in the Pediatric Patient / Family.- Changing Landscape of Surgical Ethics.- Management of Fatal Diseases in the Neonate.- Destination ECMO in the Pediatric Patient.  (Pro/Con).- ECMO as a Terminal Event.- Brain death in NICU/PICU.- Ethics of Fetal Interventions for Lethal Anomalies.- Critical Care.- Dealing with Families of Patients with severe Brain Injury: Turning off Support, Organ Donation.- Ethical Dilema when a Mechanical Assist Device is Futile.- Burned Beyond Recognition. Ethics of Care.- Do Not Resuscitate/ Palliative Care/ End of Life.- Peri-Operative DNR: An Ethical Dilema.- Approach to Palliative Surgery at End of Life.- Conflicts with Surrogate Decision Makers and Goals of Care.- Global Surgery.- Medical Missions to Developing Countries (Pro/Con).- Rebuttal: The View From The Lake Tanganyika Floating Clinic.- Why is No Program Training "The Complete Surgical Missionary?".- One Can Make a Difference in National Health Policy. The Transplant Program in China.- Surgical Innovation/ Research.- Ethical Questions of Surgical Trials.- Introducing New Techniques, Technology and Medical Devices.- Uterine Transplantation: More than Saving a Life.