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Ann Thorac Surg 2004;77:758-760
© 2004 The Society of Thoracic Surgeons

Ethics in cardiothoracic surgery

Con

Lawrence H. Cohn, MD

The first 20% of the full text of this article appears below.

The ethical question being discussed underscores the dilemma of surgeons possessing varying degrees of skill related to a complex operation and whether or not they should refer to surgeons with greater experience. For the purposes of this debate, I have taken the con position in the following essay.

In the ideal world, the best surgeon in the world for a particular disease or condition would operate on every patient with that condition. Obviously, this is not practical or desirable. It would not be physically possible for only a few surgeons to do all of the operations of a particular type, and it would be undesirable not to disseminate knowledge of a new technique. Surgeons going through American thoracic training programs believe that they are competent enough to do most procedures that are required for the American Board of Thoracic Surgery certification, provided they have had exposure to said techniques. The chief of the cardiothoracic surgery service certifies that a trainee is technically and intellectually competent to take the American Board of Thoracic Surgery examination, which determines board certification. The American Board of Thoracic Surgery certificate indicates that this person has demonstrated cognitive and judgmental knowledge satisfactory to practice cardiothoracic surgery in all its aspects. Given the proper environment after training, most of these individuals will learn complex procedures and learn to do them well either as a trainee or as a practitioner. Surgeons who do not attempt to learn complex procedures after training will not gain the necessary training experience to perform the procedures safely. Thus, in this debate . . . [Full Text of this Article]






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