June 30, 2022

“Never say die”: the surgeon’s motto?

‘When the patient of an internist dies, his colleagues ask, “What happened?,” when the patient of a surgeon dies, his colleagues ask, “What did you do?”,’ medical ethicist and sociologist Charles L. Bosk once said. A study in the July issue of Annals of Surgery backs this up. Margaret L. Schwarze, of the University of Wisconsin, and colleagues surveyed a number of neurosurgeons, cardiothoracic surgeons and vascular surgeons.

They found that nearly two-thirds of surgeons would be unwilling to end patients’ request to withdraw life support if they had operated on them. And they would be even more reluctant if they had made a mistake.“Surgeons who feel responsible for the life of their patient and the role that they played in an unwanted outcome have difficulty relinquishing the goal of patient survival.”

The authors of the article speculate that a surgeon’s sense of responsibility for the patient could conflict with patient autonomy.

“Iatrogenic complications that clearly derive from technical errors during elective procedures may pose considerable guilt and emotional burden upon surgeons,” the authors speculated. “It is understandable that such factors should weigh on the surgeon. However, our findings call into question the degree to which these factors may unduly interfere with a patient’s ability to control his or her health care decisions.”

“I’ve been practicing for 10 years, and I’ve seen this happen,” Dr Schwarze, a vascular surgeon, told American Medical News. “It’s like, ‘Gosh, we did all this stuff to save you and now you want to quit on me?’ ” This is not necessarily due to fear of litigation over possible errors. Surgeons also tend to feel more optimistic about patients’ recovery. ~ Annals of Surgery, July

Michael Cook
Creative commons
informed consent
withdrawal of life support