Ethical considerations in orthopaedic surgery

Because our actions as physicians have far-reaching consequences, and because society allows us to do things to others that no one else is free to do, physicians' professional activities fall under the domain of ethical evaluation. We are charged with the obligation to use specialized scientific knowledge, to work in concert with others, and to act for the good of our patients. In fact, acting for the good of our patients is the central tenet of ethical medical behavior. What constitutes the good of the patient, however, is not always clear. In general, we act to limit disease, restore function, alleviate suffering, and prolong life. We understand fully, however, that these goals may conflict with one another. Judgment about what is right for a particular patient leads us to another crucial consideration of ethical behavior, namely, respect for patient autonomy. We recognize that individuals have the right to control their own destiny. Patients have a right, therefore, to make choices about their medical care. As physicians, we must respect those rights. As such, certain ethical behavior is expected of us. We must be honest with our patients. We must provide them with accurate information on which to base their decisions. We must convey to them information about their diagnosis, prognosis, and treatment, even when it is unpleasant to do so. We must be open about our expertise and level of training for a particular procedure. We must respect their privacy and their right to withhold information even from family and friends. In short, we must respect their choices, even if we may disagree with those choices. To truly respect patient autonomy is to understand that, ultimately, the final decision lies with the patient.