The Ethics of Neurosurgical Training

Abstract

From a historical perspective, one of the fundamental tenets of medicine is the need to “First do no harm” and this is central to the surgical ethos of protecting patients when they are at their most vulnerable as they are when they submit themselves to a general anaesthetic and the skills and judgement of a surgeon. In these circumstances, patients have every right to expect that the surgeon into whom they have placed their trust is not only competent to perform the procedure but also to manage unexpected complications as and when they occur.

However, adopting this position fails to recognise the practicality of surgical practice because all surgeons must make the transition from complete novice, through intermediate competency and eventually to expert independent performer.

The question arises as to how these difficult practical and ethical issues should be addressed in an objective manner that is fair not only to the patient and society, but also to the surgical community who are tasked with providing the next generation of surgical experts.

This chapter will outline the ethical issues that need to be considered and also provide a practical framework which can be used to resolve some of the problems encountered.