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Ann Thorac Surg 2007;84:723-728
© 2007 The Society of Thoracic Surgeons

Ethics in Cardiothoracic Surgery

A Surgeon Operates on His Son: Wisdom or Hubris?

Kenneth Oberheu, MDa, James W. Jones, MD, PhDb, Robert M. Sade, MDc,*

a Private Practice, Kiawah Island, South Carolina
b Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
c Department of Surgery and the Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina

* Address correspondence to Dr Sade at Department of Surgery, 96 Jonathan Lucas Street, Suite 409, PO Box 250612, Charleston, SC 29425 (Email: sader@musc.edu).

The first 300 words of the full text of this article appear below.


   Introduction
 
Robert M. Sade, MD
Nearly all physicians have had opportunities to play doctor to family members: inspecting a sore throat, peering at an eardrum, or writing an antibiotic prescription. Some may have done minor operations such as suturing a minor laceration. Fewer have considered doing a major operation on a family member, yet circumstances of this kind do arise from time to time and may cause consternation among colleagues. Such situations have come to our attention recently, and one of them is presented in the following case, in which the names and certain details have been changed. We presented the case to two cardiothoracic surgeons who have differing views on how a surgeon should respond when faced with a family member’s need for major surgical care.


   The Case of the Confident Surgeon
 
Michael is 25 years old and won a silver medal in the pentathlon at the 2004 Olympics. The pentathlon consists of pistol shooting, fencing, swimming (200-m free-style), equestrian show jumping (350- to 450-m course with 15 jumps), and running (3 km cross-country). He is among the rare Olympic athletes who wear a prosthetic heart valve, having undergone an urgently performed aortic valve replacement 8 years ago for acute valve endocarditis while traveling in Australia. In January 2006, Michael notices shortness of breath and decreasing stamina during training. He is found to have a new diastolic murmur, and echocardiography shows mild aortic insufficiency with structural deterioration of the bioprosthetic valve and calcification of its leaflets.

He is told that the prosthesis could fail at any time and needs to be replaced. Michael is anxious to continue his Olympic training to compete in the 2008 games and does not want a mechanical prosthesis because of the requirement for anticoagulation in view of possible trauma during his rigorous training and competition. The consensus among his care team is that the best . . . [Full Text of this Article]






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