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Why surgeons can say "no": exploring "unilateral withholding"
Constantine A Manthous1, Michael Ivy
1Bridgeport Hospital, Bridgeport, CT, USA. pcmant@bpthosp.org
Journal of Hospital Medicine
|January 7, 2012
Summary
Surgeons can unilaterally withhold surgery, but withholding cardiopulmonary resuscitation (CPR) is less common in the US. This difference may stem from medical education, risk aversion, and heuristics influencing life-saving therapy decisions.
Area of Science:
- Medical Ethics
- Surgical Decision-Making
Background:
- Discrepancy exists in the unilateral withholding of surgery versus cardiopulmonary resuscitation (CPR).
- This variability impacts medical and surgical practitioners, influencing life-saving therapy decisions.
Observation:
- Literature search reveals no direct studies on this specific decision-making disparity.
- Interprovider variability in risk aversion and heuristics affects clinical judgment.
Findings:
- Medical-surgical education, heuristics, and risk aversion influence decisions on offering or withholding life-saving treatments.
- Surgeons' unilateral withholding of surgery is permissible, unlike CPR in the US.
Implications:
- Clinicians and surgeons should consider factors influencing withholding life-saving therapies.
- Pursuing second opinions is advised when uncertainty exists regarding forgoing surgery.
- Informed consent is crucial for facilitating beneficence, especially when withholding CPR.
