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.

Tragic knowledge: truth telling and the maintenance of hope in surgery.

Surgeons often are faced with the challenge of balancing truth telling and the maintenance of hope in the setting of a poor prognosis. This ethical dilemma is informed by conflicting appeals to principles of autonomy and nonmaleficence, where a patient's right to be told important medical information must be weighed against the potential harm that may result from the knowledge of an unfavourable diagnosis. Truth telling in surgery raises questions on the nature of truth itself, how much information ought to be shared, what information can be withheld, and how surgeons should share tragic knowledge with patients.

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.

Withdrawing life-sustaining treatment: ethical considerations.

Withdrawing life-supporting technology from patients who are irremediably ill is morally troubling for caregivers, patients, and families. Interventions that enable clinicians to delay death create situations in which the dignity and comfort of dying patients may be sacrificed to spare professionals and families from their elemental fear of death. Understanding of the limits of treatment, expertise in palliation of symptoms, skillful communication, and careful orchestration of controllable events can help to manage the withdrawal of life support appropriately.