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Ann Thorac Surg 2000;70:1758
© 2000 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Department of Surgery, University of Missouri School of Medicine, M580 Health Sciences Center, One Hospital Dr, Columbia, MO 65212, USA,

e-mail: jonesj{at}health.missouri.edu

To the Editor

The writers appear to have mistaken my acknowledgement of an article in the lay press for methodological criticism of the science that went into Heartport. I specifically cited The Wall Street Journal article, rather than the surgical literature, as a cautionary tale about potential conflicts of interest and premature introduction of innovations, and to promote consideration of the ethical implications of new technology and its application. I offered no judgement about either the scientific or ethical merits of the Heartport experience, suggesting instead that The Wall Street Journal article "should cause all surgeons to examine their practices with respect to technology" [1]. Dr Monro’s editorial in the same issue cites still another case of cardiac surgeons failing to appreciate ethical ramifications until nonsurgeons became their teachers [2].

My comments attempted to address not whether a technology is clinically beneficial, economically rewarding, or even a worthwhile intermediate step in the advancement of surgical therapy, but the crucial issue that surgeons as fiduciaries must balance technologic advancement and ethical responsibilities, a subject rarely broached in our data-driven surgical publications. Ethical reasoning and scientific methodology are different and equally important intellectual constructs, both worthy of the readership’s attention. The fact that our ethical values are being evaluated in the public press should increase our alertness to their importance, rather than give us license to dismiss their relevance.

The "ethics gap" in surgery is becoming more apparent [3]. As a task-oriented specialty, we must continually remind ourselves that positive scientific outcomes do not justify ethical breaches. Ethical impropriety does not require scientific wrongdoing for substantiation; it is inherently wrong. I am grateful to Dr Colvin and his colleagues for illustrating the confusion that can follow when one relies solely on surgical science as the measure of good practice.

References

1. Jones J.W. Ethics of rapid surgical technological advancement [Editorial]. Ann Thorac Surg 2000;69:676-677.[Free Full Text]
2. Monro J.L. Lessons to be learnt from the bristol affair [Editorial]. Ann Thorac Surg 2000;69:674-675.[Free Full Text]
3. Sade R.M., Williams T.H., Perlman D.J., Hanley C.L., Stroud M.R. Ethics gap in surgery. Ann Thorac Surg 2000;69:326-329.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James W. Jones Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jones, J. W. Search for Related Content PubMed Articles by Jones, J. W. Related Collections Related Article