Vascular surgeon and bioethicist Margaret L. Schwarze, MD, MPP, FACS, will discuss informed consent and shared decision making during Wednesday’s John J. Conley Ethics and Philosophy Lecture, What We Talk about When We Talk About Surgery.
The question of whether or not surgery is the appropriate answer to a medical problem is complicated by the very real impulse to preserve life at all costs, noted Dr. Schwarze, associate professor of surgery and bioethics, University of Wisconsin School of Medicine and Public Health, Madison.
“It’s human nature to want to rescue,” she said. “We are obsessed with rescue, and many decisions about surgery are about emotion and not rationality. There are many surgeons who suffer a fair amount of distress about being asked to operate on somebody who is at the end of life and shows up with a surgical problem. You think, ‘Sure, I can do this operation. But I don’t like the idea of assaulting this person with a major operation right before they die.’”
Patients and family members typically think of surgery in terms of solving a specific problem, perhaps replacing a malfunctioning mitral valve or removing an infected colon. Surgeons are often trained to adopt a similar thought process: See a problem, find the sur-gical solution, do the operation.
But any procedure has its risks, tradeoffs, and uncertain out-comes with any surgery. Informed consent requires surgeons to discuss risks and uncertainties in copious detail. But these conversations seldom include a realistic explanation of the tradeoffs involved or how surgery will affect the patient’s overall functioning, Dr. Schwarze said.
Shared decision making can help the patient, family members, and caregivers better understand the tradeoffs. But the communication skills required to educate the patient and share decision making at a significant level don’t just happen, Dr. Schwarze said. Those skills must be learned through practice, feed-back, and repetition.
“How we, as surgeons, work through those conversations is important,” Dr. Schwarze said. “At the end of the day, we aren’t operating on ourselves. What we do is harm people in order to help them. The real question is whether or not those tradeoffs and potential consequences are right for each individual patient.”
The John J. Conley Ethics and Philosophy Lecture is sponsored by the Committee on Ethics and has been generously supported since 1991 by John J. Conley, MD, FACS, New York, NY, to explore ethical issues in surgery. Dr. Conley died in 1999, but his legacy continues and his memory is honored at this annual lecture.
John J. Conley Ethics and Philosophy Lecture
What We Talk about When We Talk about Surgery
Margaret L. Schwarze, MD, MPP, FACS
9:45–10:45 am, Wednesday
Moscone Center South, 303–304