V101 No 7 BULLETIN American College of Surgeons
by Lindsey Moses; Ira J. Kodner, MD, FACS; Douglas Brown, PhD;
Brian Nussenbaum, MD, FACS; and Jennifer Yu, MD
As a cornerstone of the surgeon- patient relationship, shared deci- sion making is a critical factor in
determining whether a patient should
undergo an elective procedure. The
decision as to whether an operation
is appropriate should be made based
on the surgeon’s understanding of
the risks and benefits of surgery and
the patient’s goals and quality of life.
In some instances, however, patients
may request a procedure in which
the surgeon believes the risks would
outweigh any potential benefit based
on the patient’s history and current
health status. Such cases present an
ethical dilemma for the surgeon.
This article describes a case in
which the surgeon believes a conservative approach to care is best based on
the patient’s history and previous postoperative complications; however, the
patient wants to pursue a more aggressive approach in order to improve her
quality of life. Details of the patient’s
history and health status are described,
and four possible means of resolving
the predicament are discussed.
Seeking
equilibrium
in decision
making: The balance
between
clinical
judgment and
patient goals
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