Surgeons’ Right to Refuse Certain Surgeries and Their Ethical Obligations

Surgeons are entrusted with lives, and thus they have a unique professional responsibility to perform surgeries when it is necessary and beneficial for the patient. However, they also have the right to refuse surgeries based on personal or professional reasons, provided that they fulfill their duty of care and ensure that the patient receives appropriate and competent medical care.

Refusal Based on Personal Reasons

Doctors, including surgeons, have the freedom to make their own decisions regarding which surgeries they will perform. In some cases, surgeons may choose to refuse to perform certain surgeries based on personal reasons. These reasons can include lack of experience, ethical concerns, or simply a sense that a more appropriate surgeon is better suited for the task. However, this decision must be balanced against the ethical obligation to provide competent care.

Emergency vs Non-Emergency Surgeries

When it comes to emergency surgeries, the ethical imperative is clear: the care of a patient's life or limb trumps individual personal preferences. For example, a surgeon may refuse to perform a fourth nose job for a patient if they feel that the case is not in line with medical best practices. However, they would not be morally or ethically justified in refusing a potentially life-saving emergency procedure such as stopping arterial bleeding in an accident victim.

Unlicensed Practitioners and Refusal to Operate

Unlicensed practitioners also have the right to refuse surgeries, particularly if it involves life-threatening or limb-threatening situations. In medical emergencies, doctors must prioritize the health and safety of the patient above all else. They are expected to provide the necessary care to stabilize the patient and refer them to a competent colleague if they are not qualified to handle the situation.

Reasons for Refusal in Licensed Surgeons

Licensed surgeons may also refuse to perform specific surgeries based on various reasons:

Ability and Expertise

Ability to Perform the Surgery: If the surgeon feels that they are not competent to perform a specific operation, they should defer to a more qualified colleague. Available Expertise: If the hospital lacks the necessary expertise to support the surgery, the surgeon should refer the patient to a more appropriate facility or specialist. Patient's Medical Condition: The patient’s overall health, comorbidities, and the potential for complications may prevent the surgeon from performing the surgery. In such cases, it is important to refer the patient to another surgeon who can address all aspects of their care. Patient Demands: If a patient is requesting a surgery that the surgeon thinks is not indicated, the surgeon should explain the risks and benefits and consider alternatives with the patient. Ethical Concerns: Some surgeons may have strong personal or ethical objections to certain procedures. While they must still maintain patient care, they can explain their reasons for refusing the surgery and refer the patient to another provider.

Historical Examples and Professional Growth

The history of medical ethics is replete with examples of how doctors and surgeons navigate these complex issues. In the mid-1980s, while in medical school in Canada, some surgical residents were told that some OB GYN residents refused to perform abortions for ethical reasons, instead choosing surgeries that they considered more complex and interesting. Patients undergoing straightforward D and Cs were routinely referred to other surgeons, ensuring that the more challenging cases were handled by those who were comfortable with them.

However, once these residents went into practice, they found themselves performing these procedures. Some surgeons were truly ethically opposed to these procedures, while others saw them as a necessary part of their practice. Over time, ethical practices and patient care were balanced, allowing physicians to maintain their ethical integrity while ensuring that patients received the care they needed.

The case of a 8-year-old girl who faced an emergency facial reconstruction is a prime example of a surgeon's ability to recognize when they are out of their depth. A highly skilled general surgeon called a dentist to assist with a complex reconstruction due to the unstable nature of the patient's condition and the critical need to secure the airway. This case not only demonstrated the surgeon's ethical and professional judgment but also reinforced the importance of recognizing when assistance is needed.

In conclusion, while licensed surgeons have the right to refuse certain surgeries based on personal or professional reasons, they are also obligated to ensure that the patient receives competent care. Ethical considerations and the duty of care are crucial in guiding these decisions, ensuring that patients receive the best possible medical attention.