Ethical and Legal Considerations

  • Ira J. Kodner
  • Mark Siegler
  • Daniel M. Freeman
  • William T. Choctaw


Professional responsibilities have been a concern of surgeons since antiquity; however, the last 25 years have displayed a dramatic growth of both professional and societal attention to moral and ethical issues involved in the delivery of health care. This increased interest in medical ethics has occurred because of factors such as the greater technological power of modern medicine, the assigning of social ills to the responsibility of medicine, the growing sophistication of patients and the information available to them, the efforts to protect the civil rights of the increasing disadvantaged groups in our society, and the continued rapidly escalating cost of health care including medical malpractice costs. All of these factors contribute to the urgency of dealing with ethical and moral issues involved in the delivery of modern surgical care.1


Advanced Directive Natural Orifice Translumenal Endoscopic Surgery Rectal Surgeon Suicidal Patient Medical Malpractice 
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  1. 1.
    ACEP Ethics Committee. Code of ethics for emergency physicians. Ann Emerg Med. 1997;30:365–72.Google Scholar
  2. 2.
    Derse AR. Law and ethics in emergency medicine. Emerg Med Clin North Am. 1999;17:307–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Kodner IJ. Ethics curricula in surgery: needs and approaches. World J Surg. 2003;27:952–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Little M. Invited commentary: is there a distinctively surgical ethics? Surgery. 2001;129:668–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press; 2001. p. 12–23.Google Scholar
  6. 6.
    Justice Cardoza. Scholendorff v. New York Hospital 105 N.E. 92. New York Court of Appeals 1914.Google Scholar
  7. 7.
    Iserson KV. Principles of biomedical ethics. Emerg Med Clin North Am. 1999;17:283–306.PubMedCrossRefGoogle Scholar
  8. 8.
    Adams J, Larkin G, Iserson K, et al. Virtue in emergency medicine. Acad Emerg Med. 1996;3:961–6.CrossRefGoogle Scholar
  9. 9.
    Alexander L. Medical science under dictatorship. NEJM. 1949;241:39–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Koenig HG. Taking a spiritual history. JAMA. 2004;291:2881.PubMedCrossRefGoogle Scholar
  11. 11.
    Weber JE. Conflicts of interest in emergency medicine. Emerg Med Clin North Am. 1999;17:475–90.PubMedCrossRefGoogle Scholar
  12. 12.
    Buckner F. The Emergency Medical Treatment and Labor Act (EMTALA). Medical Practice Management 2002;Nov/Dec:142–5.Google Scholar
  13. 13.
    Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical decisions in clinical medicine. 5th ed. New York: McGraw-Hill; 2002. p. 41–2.Google Scholar
  14. 14.
    Moore FD. Ethical problems special to surgery: surgical teaching, surgical innovation, and the surgeon in managed care. Arch Surg. 2000;135:14–6.PubMedCrossRefGoogle Scholar
  15. 15.
    MdKneally MF. Ethical problems in surgery: innovation leading to unforeseen complication. World J Surg. 1999;23:786–8.CrossRefGoogle Scholar
  16. 16.
    McCahill LE, Dunn GP, Mosenthal AC, et al. Palliation as a core surgical principle: part I. J Am Coll Surg. 2004;199:149–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Jacobstein CR, Baren JM. Emergency department treatment of minors. Emerg Med Clin North Am. 1999;17:341–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Schmidt TA, Zechnich AD. Suicidal patients in the ED: ethical issues. Emerg Med Clin North Am. 1999;17:371–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Angelos P. End of life issues. American College of Surgeons Ethics Curriculum for Surgical Residents, pp. 91–2.Google Scholar
  20. 20.
    Sander AB. Advance directives. Emerg Med Clin North Am. 1999;17:519–26.CrossRefGoogle Scholar
  21. 21.
    Siegler M. Identifying the ethical aspects of clinical practice. Bull Am Coll Surg. 1996;81(11):23–5.PubMedGoogle Scholar
  22. 22.
    Ells C, Caniano DA. The impact of culture on the patient-surgeon relationship. J Am Coll Surg. 2002;195:520–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Paris JJ, Ferranti J. The changing face of medicine: health care on the Internet. J Perinatol. 2001;21:34–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Moore GP. Ethics seminars: the practice of medical procedures on newly dead patients – is consent warranted? Acad Emerg Med. 2001;8:389–92.PubMedCrossRefGoogle Scholar
  25. 25.
    McKneally MF, Daar AS. Introducing new technologies: protecting subjects of surgical innovation and research. World J Surg. 2003;27:930–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Nee PA, Griffiths RD. Ethical considerations in accident and emergency research. Emerg Med J. 2002;19:423–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Beecher HK. Ethics and clinical research. NEJM. 1966;274:1354–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Rothman DJ. Ethics and human experimentation: Henry Beecher revisited. NEJM. 1987;317:1195–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Horng S, Miller FG. Is placebo surgery unethical? NEJM. 2002;347:137–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Birrer R, Singh U, Kumar DN. Disability and dementia in the emergency department. Emerg Med Clin North Am. 1999;17:505–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Schears RM. Emergency physicians’ role in end-of-life care. Emerg Med Clin North Am. 1999;17:539–59.PubMedCrossRefGoogle Scholar
  32. 32.
    Iserson KV. Withholding and withdrawing medical treatment: an emergency medicine perspective. Ann Emerg Med. 1996;28:51–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Marco CA. Ethical issues of resuscitation. Emerg Med Clin North Am. 1999;17:527–38.PubMedCrossRefGoogle Scholar
  34. 34.
    Marco CA, Larkin GL. Ethics seminars: case studies in “­futility” – challenges for academic emergency medicine. Acad Emerg Med. 2000;7:1147–51.PubMedCrossRefGoogle Scholar
  35. 35.
    McCahill LE, Dunn GP, Mosenthall AC, et al. Palliation as a core surgical principle: part I. J Am Coll Surg. 2004;199:149–59.PubMedCrossRefGoogle Scholar
  36. 36.
    The rights of the terminally ill. New York Times 5/28, 2004.Google Scholar
  37. 37.
    Liptak A. Ruling upholds Oregon law authorizing assisted ­suicide. New York Times 5/27, 2004.Google Scholar
  38. 38.
    Daniels S. Good Samaritan Acts. Emerg Med Clin North Am. 1999;17:491–504.PubMedCrossRefGoogle Scholar
  39. 39.
    Jones JW, McCullough LB. Consent for residents to perform surgery. J Vasc Surg. 2002;3:655–6.CrossRefGoogle Scholar
  40. 40.
    Wu AW, Cavanaugh TA, McPhee SJ, et al. To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. J Gen Intern Med. 1997;12:22–7.CrossRefGoogle Scholar
  41. 41.
    Krizek TJ. Ethics and philosophy lecture: surgery…is it an impairing profession? J Am Coll Surg. 2002;194:352–66.PubMedCrossRefGoogle Scholar
  42. 42.
    Self-treatment or treatment of immediate family members. American Medical Association Policy Number E-8.19.Google Scholar
  43. 43.
    Jones JW, McCullough LB, Richman BW. An impaired surgeon, a conflict of interest, and supervisory responsibilities. Surgery. 2004;135:449–51.PubMedCrossRefGoogle Scholar
  44. 44.
    Hayward R. The shadow-line in surgery. Lancet. 1987;1(8529):375–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Ira J. Kodner
    • 1
  • Mark Siegler
    • 2
  • Daniel M. Freeman
    • 3
  • William T. Choctaw
    • 4
  1. 1.Department of SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Medicine and Surgery, Lindy Bergman Distinguished Service Professor, Director, MacLean Center for Clinical Medical Ethics, Department of Medicine Ethics CenterUniversity of ChicagoChicagoUSA
  3. 3.Washington Semester ProgramAmerican UniversityWashingtonUSA
  4. 4.Department of SurgeryCitrus Valley Medical CenterCovinaUSA

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