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Ethics in Cardiothoracic Surgery

Should Sleep-Deprived Surgeons Be Prohibited From Operating Without Patients' Consent?

^a Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
^b Department of Surgery, University of Washington, Seattle, Washington
^c Institute of Human Values in Health Care, Clinical Research Ethics Core of the South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, South Carolina

^_* Address correspondence to Dr Sade, Medical University of South Carolina, 25 Courtenay Dr, Ste 7028, MSC 295, Charleston, SC 29425-2270 (Email: sader@musc.edu).

Presented at the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.

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

	Introduction

 
Robert M. Sade, MD
The effects of sleep deprivation on performance of physicians has been widely studied ever since the death of Libby Zion in 1984, the subsequent campaign by her parents and others to regulate physician work hours, and the passage of the so-called Libby Zion Law by New York State in 1989 [1]. Impetus was added to investigations of the effects of sleep deprivation when the Accreditation Council for Graduate Medical Education (ACGME) adopted similar standards for accreditation of residency programs in the United States in 2003 [2]. While sleep deprivation clearly affects mental and physical functioning, results of investigations of clinical outcomes have been mixed—some finding adverse effects on patient care, others finding no such effects [3–6].

The arguments for regulating work hours of residents have been extended to apply in a more limited way to attending surgeons. In a recent issue of the New England Journal of Medicine [7], two medical ethicists and a sleep specialist published a paper that opened with this scenario: "A surgeon on overnight call responds to an 11 PM call from the hospital, where a patient has presented with an acute abdomen. After working up the patient for several hours, the surgeon decides to ... perform a bowel resection. By the time the procedure is completed ... it is time for morning rounds. The surgeon has not slept all night and is scheduled to perform an elective colostomy at 9 AM."

The sleep specialists followed the vignette with a series of questions [7]: Does the surgeon have an obligation to disclose to the patient the lack of sleep during the past 24 hours and obtain new informed consent? Should the surgeon give the patient the option of postponing the operation or requesting a different . . . [Full Text of this Article]