Ask the Ethicist: What an
ex-girlfriend taught me
about surgery

April 3, 2012 8:01 pm Views: 164
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Kenneth W. Kirkwood, Ph.D is Assistant Professor of Ethics in the Faculty of Health Sciences The University of Western Ontario and writes Ask the Ethicist monthly for Hospital News.

I once dated a woman who was discussing the untimely demise of a friend’s relationship due to infidelity. During that conversation, the kind in which people harshly judge the unfaithful party, she dropped a bomb. She confessed that she always told the truth, but that didn’t mean she had to tell someone everything, just never lie. I imagine you’re saying to yourself “how did you let that one get away?” You may also be protesting at the fine, and self-serving, distinctions she made between the truth and the “whole” truth.

Fast forward 10 years and in the midst of an education day with surgical residents, the issue of the supervision of residents during surgery came up. To my great unease, it became apparent that surgical residents have been left without any direct supervision by senior physicians while operating on patients. The unnerving part of it is that the patients consented to being operated on by residents who were being supervised by an experienced surgeon. As the discussion carried on, some confessed to supervising numerous surgeries – as many as four – at the same time. This is all allowable, in part, because patients “consent” to it. The patients consented to it, I proposed, because what they imagine as supervision was different than what actually happens.

In common conversation, we use “truthfulness,” “honesty,” “not lying” and “truth” as synonyms. The assumption we make with each one implies the other.

Our common sense of honesty suggests that by telling the truth, I’m being honest and not lying. But the definitions are a little finer than that. Truth is just that – the statement is true and if it is a factual statement, it can be verified. But one could, tell no lies and yet deceive another by leaving certain details out.

When we use the term “honesty” in medical ethics, we speak of sharing the true impressions we have about a patient’s case, but more than that, we speak of the complete impressions we have about that patient’s case. To omit some relevant fact or opinion which is owed to the patient is not technically lying – since everything said is true – but it is deception, which is trying to create a false impression in the patient’s mind, and that is dishonest and unethical.

Maybe some of you reading this in waiting rooms around Canada are waiting for your own surgery. Ponder this: if the physician tells you that a resident will perform your surgery under his or her supervision, what do you imagine? You’re probably thinking of a hovering senior surgeon watching over a slightly nervous resident, correcting every move and coaching the resident throughout the procedure. The reality is that the supervising physician may be moving between multiple operating theatres at the same time, leaving your surgery for prolonged periods of time. Is that what you imagined? Probably not.

I would suggest that you ask the physician what “supervising” means, and how much in-person guidance will actually be offered. Even surgeons are sometimes vague about describing what “supervision” meant, they can’t lie to you in answering your questions – so ask. Don’t assume that just because your surgeon is a caring, skilled professional with a good reputation doesn’t mean that he or she isn’t going to take calculated risks with your health to manage his or her patient load.

I’m sure someone will email me to say that things are not as bad as all this, but consider this: at one Ontario hospital which I was visiting in the past year, I was reassured that they had recently passed a rule that supervising physicians had to be on hospital grounds while their residents were operating. I can imagine that being supervised from another part of town, the country, or the world, is definitely not what patients have in mind when they are told “supervision.”

Article By:

Kenneth W. Kirkwood

Kenneth W. Kirkwood, Ph.D is Assistant Professor of Ethics in the Faculty of Health Sciences at The University of Western Ontario. To submit a question to "Ask the Ethicist" please contact kkirkwo2@uwo.ca

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