Background. Discussion of ethical issues occurs much less often in the surg
ical than in the medical literature. The reasons for this "ethics gap" are
unknown.
Methods. Our clinical faculty ranked the ethical and legal acceptability of
four treatment options in two cases of surrogate decision making. Only one
option in each case was ethically and legally unacceptable (treating despi
te objection by the surrogate decision maker).
Results. Surprisingly often, faculty mistakenly believed the ethically unac
ceptable option to be acceptable, and the legally unacceptable option to be
acceptable. Surgeons were not ethically different from other physicians. S
urgeons (19 of 31, 62%), however, were significantly (p < 0.05) more likely
than internists (18 of 51, 35%) or pediatricians (4 of 18, 22%) to believe
, mistakenly, that operating on the baby without parental consent was legal
ly acceptable.
Conclusions. This pilot study did not identify why the surgical literature
contains a relative dearth of ethics discussion. Broader investigations are
needed, because it is important that we understand the reasons for the gap
. Surgeons' strong ethic of personal responsibility for patients' welfare s
hould be transmitted to young trainees, a goal best achieved by discussing
and writing about ethics. Moreover, our legal data suggest that a gap may a
lso exist between surgeons and other physicians in understanding health law
. (C) 2000 by The Society of Thoracic Surgeons.