Medical ethics are at the core of practice of medicine as a guide to behavior and decision making. Like other specialists, surgeons also have a responsibility to protect the wellbeing of their patients. 

Some ethical concerns are unique to surgeons. Surgery is invasive and cuts the body and so can be viewed as contradictory to the axiom “primum non nocere”. Before it heals the body, it hurts the body. Surgeons must separate the soul and the body and consider the body to be an “object”. Also, decisions to perform a surgery are often made in an emergency situation or uncertain circumstances. Any decision must be made keeping the best interests of the patient and also respect the wishes of the patient and/or their families. Surgeons may come to question their choices, but it is thus legally and ethically accepted to not operate on a patient if it is considered to be obstinacy or futile. According to the authors, the four-box model (respect for autonomy, beneficence, nonmaleficence and justice) can be used as a guide to discussion on surgical ethics. 

Ethical dilemmas arise when making the choice to act in a particular way in situations where the right answer is not obvious. Explaining the rationale for choosing a particular surgical intervention or decision also poses ethical challenges. The four areas to be addressed include medical indications, patient preferences, quality of life and contextual features i.e. other aspects of the patient’s life and his desires. The ethics of the relationship between surgeon and his patient are defined by the following five moral principles:  Rescue, proximity, ordeal, aftermath and presence. This article has also discussed the characteristics that make for a good competent surgeon. These include good clinical and technical skills, right surgical judgment, expertise in surgery as well as knowledge and practice of humanism, ethics, and solid moral values. Difficult ethical decisions should be placed before an ethical committee before making a decision. Making ethics part of education will make the surgeon better equipped to deal with ethical conundrums in their daily practice. “The practice of surgery is based on the technical capabilities of the surgeon (techne), their knowledge (episteme) and their capacity of judgment (phronesis).”

Cardenas D. Rev Col Bras Cir. 2020 Jun 15;47:e20202519