Surgical ethics: a framework for surgeons, patients, and society

Summary The practice of surgery is based on the technical capabilities of the surgeon (techne), their knowledge (episteme) and their capacity of judgment (phronesis). Surgeons face situations that call into question moral choices and face ethical difficulties in their daily practice. In fact, innovation is increasing, and as operations become more complex and the risks become greater, the tools necessary to approach an ethically challenging surgical case become more important. Surgical ethics can be distinguished from other medical ethics fields because of its unique characteristics and goals. Ethics lie at the core of professionalism: a proficient surgeon is considered to be not only competent to perform the art and science of surgery as traditionally understood, but also to be ethically and morally reliable. The principlism and the four-box model approaches to clinical ethics could serve as a guide to the surgical ethics discussion. There are five categories of experience and relationships that are especially important in surgery-rescue, proximity, ordeal, aftermath and presence. Ethical reasoning should help surgeons to gives answers to the questions: What should be done? Has the right decision in this situation been made? The following article is presented with the intent of encouraging thought and dialogue about ethical considerations relevant to the practice of surgery. For that reason, we will first define the scope of surgical ethics, then we will present the main ethical issues faced by surgeons and how surgeons deal with them. Finally, I will show the implications of the development of surgery ethics for patients, surgeons and society.

摘要：外科诊疗实践植根于外科医师的技艺（techne）、专业学识（episteme）与判断能力（phronesis）。外科医师在日常诊疗中常会遭遇需要做出道德抉择的场景，并面临各类伦理困境。事实上，随着外科技术创新迭代加速，手术操作日趋复杂、风险亦随之升高，应对具有伦理挑战性的外科病例所需的伦理决策工具愈发重要。

外科伦理学因其独特的学科特征与目标，可与其他医学伦理学分支相区分。伦理是职业精神的核心：一名合格的外科医师不仅需具备传统认知中开展外科诊疗的技艺与科学能力，亦需拥有可靠的伦理与道德操守。临床伦理学中的原则主义（principlism）与四盒模型（four-box model）可作为外科伦理讨论的指导框架。

外科领域有五类尤为重要的经验与关系范畴：救治、医患紧密联结、病痛磨难、术后后续与医师在场关怀。伦理推理应能帮助外科医师解答如下问题：应当采取何种措施？当前情境下是否已做出正确决策？

本文旨在引发学界对与外科诊疗实践相关的伦理议题的思考与讨论。基于此，本文将首先界定外科伦理学的研究范畴，随后阐述外科医师面临的主要伦理议题及其应对方式。最后，本文将探讨外科伦理学发展对患者、外科医师乃至整个社会的深远影响。