McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery , Volume 2 4th Edition ( 2018 ) Ebook PDF download
McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery , Volume 2 4th Edition ( 2018 ) Ebook PDF download Although the ethical precepts of respect for persons, beneficence, nonmaleficence, and justice have been fundamental to the prac- tice of medicine since ancient times, ethics has assumed an increasingly visible and codified position in health care over the past 50 years. The Joint Commission, the courts, presidential commissions, medical school and residency curriculum plan- ners, professional organizations, the media, and the public have all grappled with determining the right course of action in health care matters. The explosion of medical technology and knowl- edge, changes in the organizational arrangement and financing of the health care system, and challenges to traditional precepts posed by the corporatization of medicine have all created new ethical questions.
The practice of medicine or surgery is, at its center, a moral enterprise. Although clinical proficiency and surgical skill are crucial, so are the moral dimensions of a surgeon’s practice. According to sociologist Charles Bosk, the surgeon’s actions and patient outcome are more closely linked in surgery than in medicine, and that linkage dramatically changes the relationship between surgeon and patient.1 Surgeon and humanist Miles Little has suggested that there is a distinct moral domain within the surgeon-patient relationship. According to Little, “testing and negotiating the reality of the category of rescue, negotiating the inherent proximity of the relationship, revealing the nature of the ordeal, offering and providing support through its course, and being there for the other in the aftermath of the surgical encounter, are ideals on which to build a distinctively surgical ethics.”2 Because surgery is an extreme experience for the patient, surgeons have a unique opportunity to understand their patients’ stories and provide support for them.
The virtue and duty of engaged presence as described by Little extends beyond a warm, friendly personality and can be taught by both precept and example. Although Little does not specifically identify trust as a component of presence, it seems inherent to the moral
depth of the surgeon-patient relationship. During surgery the patient is in a totally vulnerable position and a high level of trust is demanded for the patient to place his or her life directly in the surgeon’s hands. Such trust, in turn, requires that the surgeon strive to act always in a trustworthy manner.
From the Hippocratic Oath to the 1847 American Medical Association statement of medical principles through the present, the traditional ethical precepts of the medical profession have included the primacy of patient welfare. The American College of Surgeons was founded in 1913 on the principles of high- quality care for the surgical patient and the ethical and compe- tent practice of surgery.
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