Ethical Challenges When Establishing Goals of Care in the Acute Care Surgical Setting

Patients and surgeons participate in shared decision making when they make healthcare decisions together, taking into account the patient's goals, values, and preferences. Surgical treatment is pursued when the potential benefits outweigh the risks, the burdens of treatment are acceptable, and no other alternatives are more appropriate for meeting the patient's goals of care. Acute care surgical problems require shared decision making, often with constraining factors that include the time-sensitive and life-threatening nature of acute surgical disease, absence of a patient's decision-making capacity, and lack of a preexisting relationship between the patient and surgeon. These factors may create ethical challenges for acute care surgeons who care for these patients.