Viewing ethics in surgical practice as applying critical thinking to issues
of human values leads to 4 levels of consideration: the individual patient
, the surgeon, surgical research and education, and surgical organizations,
This perspective starts with quantitative and qualitative feedback from pa
tients, studies of the process of surgical decision making, and understandi
ng how surgeons matter in preoperative counseling and postoperative recover
y. Surgeons should become as active in research on the psychosocial aspects
of surgical care as they are in research on the biological. Based on this
information, surgical training should become explicit in preparing surgeons
for patient-centered management of surgical care. Finally, surgical organi
zations can help by recognizing research in the human values domain, settin
g standards that recognize feedback from patients, and addressing more form
ally the needs of underserved populations. This approach fails to give the
basis for clear answers but gives priority to more understanding of the mor
al dilemmas faced by patients and their surgeons.