Patient-reported Limitations to Surgical Buy-in: A Qualitative Study of Patients Facing High-risk Surgery.

Objective: To characterize how patients buy-in to treatments beyond the operating room and what limits they would place on additional life-supporting treatments.

Background: During a high-risk operation, surgeons generally assume that patients buy-in to life-supporting interventions that might be necessary postoperatively. How patients understand this agreement and their willingness to participate in additional treatment is unknown.

Patient views on financial relationships between surgeons and surgical device manufacturers.

Background: Over the past decade, revelations of inappropriate financial relationships between surgeons and surgical device manufacturers have challenged the presumption that surgeons can collaborate with surgical device manufacturers without damaging public trust in the surgical profession. We explored postoperative Canadian patients' knowledge and opinions about financial relationships between surgeons and surgical device manufacturers.

Methods: This complex issue was explored using qualitative methods.

"And I think that we can fix it": mental models used in high-risk surgical decision making.

Objective: To examine how surgeons use the "fix-it" model to communicate with patients before high-risk operations.

Background: The "fix-it" model characterizes disease as an isolated abnormality that can be restored to normal form and function through medical intervention. This mental model is familiar to patients and physicians, but it is ineffective for chronic conditions and treatments that cannot achieve normalcy.

It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations.

Objective: To identify the processes, surgeons use to establish patient buy-in to postoperative treatments.

Background: Surgeons generally believe they confirm the patient's commitment to an operation and all ensuing postoperative care, before surgery. How surgeons get buy-in and whether patients participate in this agreement is unknown.

Patients' views on surgeons' financial conflicts of interest.

Background: The U.S. Department of Justice's investigations into financial relationships between surgical device manufacturers and orthopaedic surgeons have raised the question as to whether surgeons can continue to collaborate with industry and maintain public trust.

Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review.

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty.

The formal and informal surgical ethics curriculum: views of resident and staff surgeons in Toronto.

Background: Understanding what staff surgeons think surgical trainees should learn and the ethical issues that trainees need to manage can strengthen surgical ethics education.

Methods: Participants were recruited from the 15 surgical specialty and subspecialty programs at the University of Toronto. Semistructured interviews and focus groups were conducted with 13 ethics coordinators from the surgical staff and 64 resident trainees.

Ethics in cardiothoracic surgery: a survey of surgeons' views.

Background: Cardiothoracic surgeons are frequently confronted with complex ethical issues. Educational efforts to help surgeons navigate such issues have been undertaken in recent years, but their effectiveness is uncertain.

Methods: A survey instrument exploring the effects of ethics educational sessions at annual meetings and publications in cardiothoracic surgery journals was sent electronically to cardiothoracic surgeons who belong to The Society of Thoracic Surgeons and the American Association for Thoracic Surgery.

Integrating bioethics into postgraduate medical education: the University of Toronto model.

Bioethics training is a vital component of postgraduate medical education and required by accreditation organizations in Canada and the United States. Residency program ethics curricula should ensure trainees develop core knowledge, skills, and competencies, and should encourage lifelong learning and teaching of bioethics. Many physician-teachers, however, feel unprepared to teach bioethics and face challenges in developing and implementing specialty-specific bioethics curricula.

Responding to trust: surgeons' perspective on informed consent.

Background: Every day thousands of surgeons and patients negotiate their way through the complex process of decision-making about operative treatments. We conducted a series of qualitative studies, asking patients and surgeons to describe their experience and beliefs about informed decision-making and consent. This study focuses on surgeons' views.

The leap to trust: perspective of cholecystectomy patients on informed decision making and consent.

Background: Although experts in ethics and law prescribe autonomous decision making as an essential component of informed consent to operative treatment, patients with esophageal cancer told us in a previous study that they preferred to entrust decision making to their caregivers in the context of life-threatening illness. The purpose of this study was to describe the patients' perspective on the process of informed decision making and consent to operative treatment in the context of a less frightening illness and intervention.

Study Design: Face-to-face interviews with 33 patients recovering from elective cholecystectomy for cholelithiasis were conducted at Toronto General Hospital in Ontario, Canada.

Ethical considerations for innovations and clinical trials.

The ethical imperative to improve practice through innovation and research finds justification in the requirements of physicians to help patients, minimize the harms of treatment and disease, and to bring the benefits of scientific medicine to those suffering from illnesses for which satisfactory treatment has not yet been developed. This article discusses the values and principles that underlie clinical trials; the need for evidence-based knowledge; the difference between research and therapy; the ethical duty to improve care through research; the challenge of conflict of interest; the relevance of clinical equipoise; the need for research review and postapproval monitoring; and the value of disseminating results to research subjects, colleagues, and the public. Public confidence and willingness to participate in clinical trials will continue if the ethical standards set by professional, government, and international bodies are met.

Introducing new technologies: protecting subjects of surgical innovation and research.

The system for protecting human research subjects is under increasing pressure. Under the currently dominant Regulatory Ethics Paradigm, clinical research protocols must be reviewed and approved by an institutional review board (IRB) or equivalent. Although the IRB was introduced into health care in part to protect patients and investigators from the inherent conflict between the best clinical interest of the individual patient and the interest of science and society in answering a clinical question, its rigorous standards and rigid framework discourage surgeons from seeking potentially valuable early IRB consultation.