Open and honest communication that seeks a consensual decision from both the patient and the surgeon
is the key to moral decision making in surgery according to an article written by Professor David Watters
in the latest issue of the Australia and New Zealand Journal of Surgery (ANZJS), the peer-review
publication of the Royal Australasian College of Surgeons (RACS).

Additionally, Professor Watters says that recognising frailty as opposed to age, and placing greater
emphasis on documentation of the discussion and decision with the patient will better assist with
advanced care planning and may avoid over-treatment or unnecessary treatment at the end of life.

Professor Watters raises some common questions faced by surgeons around when to operate on a
patient who may insist on a procedure when there are high risks of complication, unplanned return to
theatre, increased hospital stay or death.

"Are we seduced to act by the patient's confidence in our ability to perform the procedure? Should we do
a procedure we would not advise to our relatives just because a patient strongly desires it?"

"The answer is, avoid 'spin' that over-sells the potential benefits of a particular operation and reflect on
values, expectations, benefits, risks and unwanted outcomes".

Professor Watters explains that listening to the patient, taking their concerns, needs and wishes seriously
and engaging in dialogue which enables the patient to make an informed decision, consensual to both the
patient and the surgeon will inevitably determine the safety, quality and outcome of care.

"When there are unexpected or unwanted outcomes, the surgeon will be best placed when such dialogue
with the patient or their medical treatment decision maker has been well documented in clinical records,"
he concludes.

Read the full article here