First, We Do Harm: Obtaining Informed Consent for Surgical Procedures
Abstract
Although many believe that the phrase “First, do no harm” was part of the Hippocratic Oath, in fact it was not. This phrase, often written in Latin (“Primum non Nocere”), seems to have first appeared in medical writing in the 17th century. However, it is obvious that many therapeutic interventions do cause at least some harm with hopes of benefitting patients in the long run. This balancing of initial harm in hope of eventual benefit is never more apparent than in the case of invasive procedures, though other examples abound, such as the administration of chemotherapy. The ethical concept of nonmaleficence, which traces its origins to the concept of primum non nocere, accurately acknowledges the concept of the need to strive to do more good than harm. Thus, it is apparent that, in a surgical operation, the surgeon is proposing to cause harm, initially, to the patient in hopes of creating an outcome that results in more good than harm. Therefore, the process of obtaining consent from the patient for a surgical operation acknowledges the fact that harm will, in fact, be inflicted on that patient, with the hope that, on balance, this harm will result in a greater overall good for the patient. It is for this reason that the modern concepts of informed consent have developed.
References
A good time to reflect on the wisdom that was Woody [Hayes] [blog]. Bucknuts. [accessed 2019 Sep 7]. https://247sports.com/college/ohio-state/Board/120/Contents/A-good-time-to-reflect-on-the-wisdom-that-was-Woody-110052113/.
Best Case/Worst Case (BC/WC) communication tool - whiteboard video. [accessed 2019 Sep 7]. https://www.youtube.com/watch?v=FnS3K44sbu0.
Bone R. 1997. Benediction: a farewell to my medical colleagues. J Crit Illn 12:439-40.
Bowler K. 2018. Everything happens for a reason: and other lies I’ve loved. New York: Random House.
Charles Spurgeon quotes: [on anxiety]. BrainyQuote. [accessed 2019 Sep 7]. https://www.brainyquote.com/quotes/charles_spurgeon_132220.
Duke A. 2018. Thinking in bets: making smarter decisions when you don’t have all the facts. New York: Portfolio/Penguin.
[Focusing of the mind]. AZ Quotes. [accessed 2019 Sep 7]. https://www.azquotes.com/quote/1396278 Twain.
Gizzi C. 2016. 13 Beautiful Maya Angelou quotes on living courageously. Fearless Soul. [accessed 2019 Sep 7]. https://iamfearlesssoul.com/13-beautiful-maya-angelou-quotes-on-living-courageously/.
Hobson’s choice. [accessed 2019 Sep 7]. The Phrase Finder. https://www.phrases.org.uk/meanings/hobsons-choice.html.
Jones JW, McCullough LB. 2014. Is “your only hope” medical treatment choice really a choice? J Vasc Surg 60:1083-4.
Jones JW, McCullough LB. 2015. To treat or not to treat: on what should surgical therapy be based? J Vasc Surg 62:1658-9.
Jones JW, McCullough LB. 2015. What is meant by high-risk consent? J Vasc Surg 62:510-1.
McCullough LB, Jones JW, Brody BA. 1998. Surgical ethics. New York: Oxford University Press.
Meador CK. 2018. A little book of doctor rules III: for Oslerian clinicians. New rev. ed. [place unknown]: [Clifton K. Meador].
Hobson’s choice. c2019. Merriam-Webster. [accessed 2019 Sep 8]. https://www.merriam-webster.com/dictionary/Hobson’s%20choice.
Philosophy 102: introduction to philosophical inquiry: Pascal’s wager. [accessed 2019 Sep 8]. https://philosophy.lander.edu/intro/pascal.html.
John Prine lyrics: “Angel from Montgomery.” AZLyrics. [accessed 2019 Sep 7]. https://www.azlyrics.com/lyrics/johnprine/angelfrommontgomery.html.
Richardson JD. 2018. Recovering from an operation. J Am Coll Surg 228:310-1.
Rosenbaum L. 2019. Cursed by knowledge. N Engl J Med 380:786-90.
Sadler GR, Huang JT, Padden CA, et al. 2001. Bringing health care information to the deaf community. J Cancer Educ 16:105-8.
Simon & Garfunkel lyrics: “The Boxer.” AZLyrics. [accessed 2019 Sep 7]. https://www.azlyrics.com/lyrics/simongarfunkel/theboxer.html.
Taylor LJ, Nabozny MJ, Steffens NM, et al. 2017. A framework to improve surgeon communication in high-stakes surgical decisions: Best Case/Worst Case. JAMA Surg 152:531-8.
Tribble C. 2016. Gimme 3 Steps: (with a nod to an American rock song from the 1970s). Heart Surg Forum 19:E80-1.
Tribble C. 2017. Grandmother rules: crucial conversations with patients and families. Heart Surg Forum 20:E2-6.
Tribble C. 2017. Knockin’ on Heaven’s Door: end of life decisions and discussions. Heart Surg Forum 20:E111-5.
Tribble C. 2019. You are the perfect age: an inquiry into surgical ethics during the arc of a career. Heart Surg Forum 22:E50-6.
William Osler quotes: [on being a great physician]. BrainyQuote. [accessed 2019 Sep 7]. https://www.brainyquote.com/quotes/william_osler_386616.
Woo YJ, Handy JR, Sade RM. 2019. First in line for robotic surgery: would you want to know? J Thorac Cardiovasc Surg 157:1934-40.
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
