Virtual Mentor. February 2010

This month in Virtual Mentor

Ethics and Innovation in Surgery

Innovations in surgical techniques and devices come about in several ways. There is design, development, and controlled research, just as there is with new drugs. Often, however, in the course of routine surgery, an emergency occurs that requires lifesaving improvisation. Or surgeons may introduce planned variations to accepted techniques to improve results. Finally, surgery that has been accepted and validated for one use may be applied in novel and experimental (i.e., “off-label”) ways. Virtual Mentor’s February contributors explore the ethical concerns about informed consent and exposure to harm posed by all forms of innovative surgery.

Responsible Progress in Surgical Innovation: A Balancing Act Catherine Frenkel

Innovation in surgery pits two fundamental ethical principles—
beneficence and nonmaleficence—
against each other.

Prophylactic Bariatric Surgery Commentary by Robert E. Brolin, MD, Bruce Schirmer, MD, and Angelique M. Reitsma, MD, MA The guidelines for patients’ eligibility for bariatric surgery have not changed since 1991, although recent data suggest there may be indications for broadening application of the surgery.

A Patient-Centered, Ethical Approach to Medical Device Innovation Kevin Z. Chao, MD, Daniel J. Riskin, MD, MBA, and Thomas M. Krummel, MD Stanford’s Biodesign Program brings together students and postgraduates in medicine, engineering, law, and business to embark on a 1- to 2-year fellowship in medical device innovation.

Deep Brain Stimulation: Calculating the True Costs of Surgical Innovation Joseph J. Fins, MD When assessing new techniques for use with marginalized populations, it is critical to consider costs and benefits free of unexamined biases. Anything less is discriminatory and unjust.

Upcoming Issues

March Global Health Ethics in Practice
April Medical Ethics Confronts Obesity
May Ethics of Plastic and Reconstructive Surgery
June Time and Resource Constraints in the Emergency Room

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