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Discussion

When Surgery Becomes Futile...

Does anyone have experience dealing with surgeons who want to either operate or continue operating when everyone in the room knows that it is futile and starts to infringe on patient dignity?  We have a CV surgeon who often operates on patients far outside the realm of what most would consider an acceptable risk profile.  We have a surgical ethics committee, but they have never stepped in even when confronted by other surgeons who have co-operated on some of these cases.  I have found myself quite uncomfortable at-times even during scrub just knowing that we should not be doing a really complex aortic arch repair on a patient with multiple co-morbidities and have other characteristics that make them really poor surgical candidates.  Unfortunately, we have lost a few on the table and a number in the CVICU.

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    I feel like this is common trait among vascular surgeons. Ours will operate literally on half dead people. 

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    I think this happens a lot at academic/ teaching hospitals , especially at the 'prestigious' ones. A lot of it has to do with ego in my opinion as well as a "good teaching case" . As a scrub RN and circulator , I am pretty vocal about my feelings to the surgeon and the rest of the team. Your best allies are the anesthesiologists . They can stop or cancel a case before it starts if they think that the patient is a bad candidate . I've had several cancel the surgery after the team has made its feelings known. Sadly, financial interests and ego's drive many of these decisions which are not in the patient's best interests. Stand firm as their advocate and make your feelings known if you get the sense from the patient during pre-op consultation that they are scared, not really wanting the surgery. I always ask the patient, " Have you had a detailed discussion about the risks and benefits of this surgery and the anesthetic and are you fully certain that you wish to proceed based on that discussion"

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