The Ethics of Surgery

Robert M. Sade, MD, is Distinguished University Professor, Professor of Cardiothoracic Surgery and Director of the Institute of Human Values in Health Care at the Medical University of South Carolina, where he also is Director of the Clinical Research Ethics Program. At MUSC, he created the Section of Pediatric Cardiac Surgery in 1975 and has concentrated mainly on biomedical ethics for the last two decades. He has written several hundred articles, book chapters, and books on cardiothoracic surgery, medical education, biomedical ethics, and health policy.

Contributors ; Preface ; Introduction ; Robert M. Sade, MD ; SECTION 1: THE PROBLEM OF SURGICAL ETHICS ; Chapter 1: Ethics Gap in Surgery ; Robert M. Sade, MD, Timothy H. Williams, MD, David J. Perlman, MA, Cynthia L. Haney, JD, and Martha R. Stroud, MS ; Chapter 2: Ethics in Cardiothoracic Surgery: A Survey of Surgeons' Views ; Thomas A. D'Amico, MD, Martin F. McKneally, MD, and Robert M. Sade, MD ; SECTION 2: PROFESSIONAL INTEGRITY ; Chapter 3: Deceiving Insurance Companies: New Expression of an Ancient Tradition ; Robert M. Sade, MD ; Chapter 4: Hepatitis C Virus-Infected Resident: End of Residency, End of Career? ; Carolyn M. Dresler, MD, MPA, Michael S. Kent, MD, Richard I. Whyte, MD, MBA, Robert M. Sade, MD ; Chapter 5: Must Surgeons Tell Mitral Valve Repair Candidates About a New Percutaneous Repair Device That Is Only Available Elsewhere? ; Eric R. Skipper, MD, Kevin D. Accola, MD, and Robert M. Sade, MD ; Chapter 6: The Surgeon's Work in Transition: Should Surgeons Spend More Time Outside the Hospital? ; Jamie Dickey, PhD, Ross M. Ungerleider, MD, Joseph S. Coselli, MD, Lori D. Conklin, MD, Robert M. Sade, MD ; Chapter 7: Should Sleep-Deprived Surgeons Be Prohibited From Operating Without Patients' Consent? ; Charles A. Czeisler, PhD, MD, Carlos A. Pellegrini, MD, and Robert M. Sade, MD ; Chapter 8: Are Thoracic Surgeons Ethically Obligated to Serve as Expert Witnesses for the Plaintiff? ; Donald C. Watson, Jr, MD, Francis Robicsek, MD, PhD, Robert M. Sade, MD ; SECTION 3: RELATIONSHIPS WITH PATIENTS - AUTONOMY AND CONSENT ; Chapter 9: Should a Jehovah's Witness Patient Who Faces Imminent Exsanguination Be Transfused? ; Keith S. Naunheim, MD, Charles R. Bridges, MD, ScD, and Robert M. Sade, MD ; Chapter 10: No Heroic Measures: How Soon Is Too Soon to Stop? ; Thomas A. D'Amico, MD, Mark J. Krasna, MD, Diane M. Krasna, CRNA, Robert M. Sade, MD ; Chapter 11. Should Surgical Errors Always Be Disclosed to the Patient? ; Constantine Mavroudis, MD, Constantine D. Mavroudis, MD, Keith S. Naunheim, MD, and Robert M. Sade, MD ; Chapter 12: Another Surgeon's Error: Must You Tell the Patient? ; Susan D. Moffatt-Bruce, MD, PhD, Chadrick E. Denlinger, MD, Robert M. Sade, MD ; Chapter 13. Impending Loss of Insurance Coverage is an Indication to Proceed With Complex, Expensive Surgery ; Anthony L. Estrera, MD , Sharon Ikonomidis, PhD, John S. Ikonomidis, MD, Robert M. Sade, MD ; Chapter 14: Ethical Obligation of Surgeons to Noncompliant Patients: Can a Surgeon Refuse to Operate on an Intravenous Drug-Abusing Patient With Recurrent Aortic Valve Prosthesis Infection? ; J. Michael DiMaio, MD, Tomas A. Salerno, MD, Ron Bernstein, JD, Katia Araujo, PsyD, Marco Ricci, MD, Robert M. Sade, MD ; SECTION 4: INNOVATION AND USES OF TECHNOLOGY ; Chapter 15: Surgical Innovation: Too Risky to Remain Unregulated? ; Haavi Morreim, PhD,, Michael J. Mack, MD, Robert M. Sade, MD ; Chapter 16: Who Should Adopt Robotic Surgery, and When? ; Jessica K. Smyth, MD, Karen E. Deveney, MD, Robert M. Sade, MD ; Chapter 17: Should Access to Transcatheter Aortic Valve Replacement Be Limited to High-Volume Surgical Centers? ; Joseph E. Bavaria, MD, Philip Green, MD, Gregg F. Rosner, MD, Martin B. Leon, MD, Allan Schwartz, MD, Robert M. Sade, MD ; Chapter 18: Should the Use of Transcatheter Aortic Valve Implantation be Rationed? ; John E. Mayer, Jr, MD, Grayson H. Wheatley III, MD, Robert M. Sade, MD ; SECTION 5: ORGAN DONATION AND TRANSPLANTATION ; Chapter 19: Heart Donation Without the Dead Donor Rule ; Franklin G. Miller, PhD, Robert M. Sade, MD ; Chapter 20: Saving Lives Is More Important Than Abstract Moral Concerns: Financial Incentives Should Be Used to Increase Organ Donation ; Benjamin Hippen, MD, Lainie Friedman Ross, MD, Robert M. Sade, MD ; Chapter 21: Prisoners on Death Row Should Be Accepted as Organ Donors ; Shu S. Lin, MD, PhD, Lauren Rich, RN, BSN, Jay D. Pal, MD, PhD, Robert M. Sade, MD ; SECTION 6: CONFLICTS OF INTEREST IN SURGERY ; Chapter 22: Politely Refuse the Pen and Note Pad: Gifts From Industry to Physicians Harm Patients ; Kenneth V. Iserson, MD, MBA, Robert James Cerfolio, MD, Robert M. Sade, MD ; Chapter 23: Should the Financial Link Between Industry and Physician Consultants Be Severed? ; Stephen J. Immelt, JD, Vincent A. Gaudiani, MD, Robert M. Sade, MD ; Chapter 24: Full Disclosure-Should Presentations and Publications Include Dollar Amounts and Duration of Surgeon-Industry Relationships? ; J. Peter Murphy, MD and Robert M. Sade, MD ; SECTION 7: ETHICAL ISSUES IN HEALTH CARE POLICY ; Chapter 25: Medical Ethics Collides With Public Policy: LVAD for a Patient With Leukemia ; Patrick M. McCarthy, MD,, Richard D. Lamm, LLB, CPA, Robert M. Sade, MD ; Chapter 26: Should Coronary Artery Bypass Grafting Be Regionalized? ; Brahmajee K. Nallamothu, MD, MPH, Kim A. Eagle, MD, Victor A. Ferraris, MD, PhD, Robert M. Sade, MD ; Chapter 27: A Clash of Rights: Should Smoking Tobacco Products in Public Places be Legally Banned? ; Carolyn Dresler, MD, MPA, Mark J. Cherry, PhD, Robert M. Sade, MD ; Chapter 28: Should a Medical Center Deny Employment to a Physician Because He Smokes Tobacco Products? ; James W. Jones, MD, PhD. MHA, William M. Novick, MD, Robert M. Sade, MD