Surgical palliative care: an enduring framework for surgical care.

Thomas R. Russell [49], Executive Director of the ACS pointed out ina recent editorial that the culture of surgery is changing and evolving, along with long-held values. He notes, "No longer is it 'my' patient, but it is 'our'patient." This shared responsibility for the surgical patient is not without peril, although this ethic has a positive application in the interdisciplinary model of palliative care. The principle of autonomy suggests that the patient, himself, shares some responsibility for a good QOL outcome. Although the focus of his remarks is fundamental change in residency training, his comments apply equally to the norms of surgical practice,especially palliative care: "We can start by building a sense of mutual respect for the broad range of individuals [including the patient and his family] involved in the care of our surgical patients, from nurses to allied health care professionals, from anesthesiologists to environmental service workers. As surgeons we must improve our communication and leadership skills, so these individuals will view us in a more positive light." Surgical palliative care is a philosophy of care that can answer this challenge. Surgeons have always been up to the challenges of their era. They never have disappointed those whom they serve in their degree of courage,practicality, and innovation, but the changing landscape of illness and culture offer new opportunities for other insights and strengths to emerge.