Book Review
Surgical Ethics
N Engl J Med 1999; 340:1446-1447May 6, 1999
- Article
Surgical Ethics
Edited by Laurence B. McCullough, James W. Jones, and Baruch A. Brody. 396 pp. New York, Oxford University Press, 1998. $49.50. ISBN: 0-19-510347-5There is an increasing need for discussion of the ethical issues faced specifically by surgeons in their practice and research. Surgical Ethics is one of the first books devoted to this topic, and it is a worthwhile beginning.
The 19 chapters were written by ethicists, surgeons, or both, depending on the topic. Some of the material is typical of a medical-ethics textbook: informed consent, confidentiality, advance directives, transplantation, care of dying patients, research and innovation, conflicts of interest within the hospital, and conflict with payers. Other themes are peculiar to surgery: operating on patients who are family members, friends, or colleagues; relationships between surgeons and other medical specialists; obligations of surgeons to nonphysician team members and trainees. Some contributors offer interesting and worthwhile new ways of looking at problems for both physicians and surgeons — for example, financial arrangements with patients; preventing and managing unwarranted biases; and dividing patients into those who require emergency surgery, those with acute conditions that do not require emergency surgery, those for whom surgery is elective, and those who are poor surgical risks and discussing issues peculiar to each group.
The writing is uneven but generally clear and concise. There is some redundancy in the chapters that classify patients according to their need for surgery. Some chapters are superb: that by R. Scott Jones and John Fletcher on the regulation of surgical practice and research, that by George Khushf and Robert Gifford on conflicts of interest, and that by Mary Faith Marshall and C.D. Smith on confidentiality. Some are not as good — for example, the section on the determination of death is inadequate.
This book takes a fresh look at ethical issues from the surgeon's point of view. It merits the attention of anyone with an interest in the ethical problems surgeons face every day.
Peter McL. Black, M.D., Ph.D.
Brigham and Women's Hospital, Boston, MA 02115
