Medical Ethics In The Operating Room

Medical Ethics
In The Operating Room
a Reminder
 Medical Ethics In The Operating Room

Objectives

• A reminder to us all
• Why ethics ?
• Examples of some existing problems.
• Examples of some practical solutions.
• Conclusions & Suggestions.
 Medical Ethics In The Operating Room

Why Ethics ?
 Medical Ethics In The Operating Room

Why Ethics ?

• In medicine we deal with confidential issues

(related directly to people’s lives, history, behavior, body,
health & disease).

• Patients put their trust in medical professionals &

expect high ethical standards.
 Medical Ethics In The Operating Room

Why Ethics ?

• Health providing teams are expected to know &

maintain a high level of ethical standard.
• Most ethical issues are standard.
• Some special ethical issues are related to:
– religion, culture, …etc
• Deficiencies in practical application of known
ethical standards exist.
 Medical Ethics In The Operating Room

Why Ethics ?

• Ethical issues are always of concern to the public.

• Any breach of ethical standards leaves harmful
effects shaking the confidence in the system.

( media controls the public opinion)

Medical Ethics In The Operating Room
 Medical Ethics In The Operating Room

Current Situation
 Medical Ethics In The Operating Room

Current Situation

• Written ethical standards:

– ? not widely applied in all hospitals.
– ? not known and/or not fully applied to all personnel
using the Operation Room.
 Medical Ethics In The Operating Room

Role of Hospitals
 Medical Ethics In The Operating Room

Role of Hospitals

• Provide the best medical treatment as well as

ethical standards.

• Leading hospitals & institutes should:

– Apply the highest ethical standards,
– Teach them to the future generations of medical
personnel.
 Medical Ethics In The Operating Room

Some Ethical Issues

In OR
 Medical Ethics In The Operating Room

Some Ethical Issues in The OR

I. Exposure of body.
II. Dress.
III. People gathering and traffic.
IV. Noise.
V. Comments and behavior.
VI. Honesty.
VII. Consent.
 Medical Ethics In The Operating Room

I. Exposure of body
 Medical Ethics In The Operating Room

Exposure of body

• Parts of body should not be exposed to others

( governed by religion )
– men : from umbilicus to knees.
– ladies : all body.

• Exceptions are allowed when necessary according

to a definite need.

• Exposure of some body parts is often necessary,

depending on procedure.
 Medical Ethics In The Operating Room

Exposure of body - Examples

• Preparation for
anesthesia
• Chest auscultation &
inspection.
• Insertion of folly
catheters.
 Medical Ethics In The Operating Room

Exposure of body - Examples

• Patient’s transfer to & from:

– Operating table,
– Recovery,
– The ward.
 Medical Ethics In The Operating Room

Exposure of body - Examples

• Positioning of patient.
• Application of tourniquet.
• Cleaning & draping.
• Removal of draping &
tourniquet.
• Application of cast.
 Medical Ethics In The Operating Room

Exposure of body

Whenever exposure is necessary,

it should be :

• Limited to parts needed only.

• In the presence of limited number of people.
• For the shortest period of time.
 Medical Ethics In The Operating Room

Exposure of body –when necessary

• Limited to parts needed only.

Often over exposure takes place !

 Medical Ethics In The Operating Room

Exposure of body - when necessary

• In the presence of limited number of people.

Often too many people around

(Drs. / Nurses / Technicians / Students/ workers)

Often unnecessary
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2 4 5 9
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Exposure of body - when necessary

• For the shortest period of time.

• Not to call in the cleaners early (to save time).

Do we really apply this ?

 Medical Ethics In The Operating Room

Suggestion

A sign “Female patient” or “Do Not Enter” outside

of the operating room.
 Medical Ethics In The Operating Room

II. Dress
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Dress - patient

• A single piece,
• Does not expose selected parts only,
• Does not cover well behind, often torn
strip ends,
• Ladies:
– Sleeves short,
– Head, face and neck cover not adequate.
• Not good for both sexes,

Not descent by any standard !

 Medical Ethics In The Operating Room

Dress - patient

• Underwear  by some policies should be removed

( even if operation is at neck ! ).
• Problems with patient’s underwear :
– uncleanliness / metal parts / nylon ?
• Solution:
– ensure and allow clean underwear.
– Provide proper disposable underwear .
 Medical Ethics In The Operating Room

Suggested Patient’s Dress

 Medical Ethics In The Operating Room

Suggested Patient’s Dress

Criteria

• Should provide adequate cover according to

local standards (religion).
• Should provide adequate local (selective)
exposure.
• Should allow quick & practical wide exposure
in emergency situations.
• Should look descent.
 Medical Ethics In The Operating Room

Suggested Patient’s Dress

 Medical Ethics In The Operating Room

Suggested Patient’s Dress

 Medical Ethics In The Operating Room

Suggested Patient’s Dress

 Medical Ethics In The Operating Room

Suggested Patient’s Dress

 Medical Ethics In The Operating Room

Dress - staff

• Lady staff  Drs., nurses, students.

• Does not meet required standards regarding :
– Design,
– Width & length,
– Areas covered ( head & body) ,
– Practicality.

( ask our lady colleagues ! )

 Medical Ethics In The Operating Room

New Staff’s Dress

Suggested and designed by our lady

colleagues
 Medical Ethics In The Operating Room

Suggested Staff’s Dress

• Proper head cover.

• Proper neck cover.
• Proper forearm cover.
• Buttons on side.
• Wide.
• Comfortable.
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Suggested Staff’s Dress

• Sleeves can be rolled

up above elbow for
draping.

• Fixed by press button

on strips pulled from
inside.
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Lady Surgeons Scrub Area

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Scrub Area

Man Lady
 Medical Ethics In The Operating Room

Scrub Area
 Medical Ethics In The Operating Room

III. People’s gathering & traffic

 Medical Ethics In The Operating Room

People’s gathering and traffic

• Often too many people in the corridors, receiving

area & OR  causes inconvenience to patients &
staff.
• Problem related to :
- behavior of staff & students.
- limited space.

(Both should be discussed & improved)

 Medical Ethics In The Operating Room

People’s gathering & traffic

Traffic at the receiving area

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IV. Noise
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Noise

• Patients coming to OR are worried  need

privacy, silence & reassurance.

• Noise should be kept to minimum.

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Noise

Discussions & stories should be in staff

rooms only, away from patients !
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V. Comments & Behavior

 Medical Ethics In The Operating Room

Comments & Behavior

• Jokes & laughing:

– Loudly,
– In front of patients,
– In a language not known to them !
– Before anesthesia,
– During procedure with local/spinal anesthesia.
 Medical Ethics In The Operating Room

Comments & Behavior

• Comments & remarks on patient’s:

– Disease,
– Body shape or weight,
– Behavior …etc.

That would not be said if patient is awake

 Medical Ethics In The Operating Room

Comments & Behavior

• Patients might see

instruments before
anesthesia:
– Scissors,
– Drills,
– Scopes,
– Saws .. etc
 Medical Ethics In The Operating Room

Comments & Behavior

Examining patients
 Medical Ethics In The Operating Room

Comments & Behavior

Examining patients

In the receiving area or in the In the OR, in front of others

corridors! before or after anesthesia
 Medical Ethics In The Operating Room

VI. Honesty
 Medical Ethics In The Operating Room

Honesty

• Patients often ask who performed surgery

• The answer should be honest & concentrate on :
– Concept of team work.
– Quality is assured.
– Supervised by the consultant / senior staff.
– Teaching / training does not reduce standards.
 Medical Ethics In The Operating Room

Honesty

Tell the truth !

• What went wrong.

• Complications.
• Unexpected incidence.
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VII. Consent
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Consent

Should not be taken in the operating room !

 Medical Ethics In The Operating Room

Conclusions & Suggestions

• Ethical issues are sensitive & important.

• Ethical standards according to religion and culture
 must be met.
• Deficiencies exist in the application of some
ethical standards.
• Need to revise policy of patient’s dress & the
ladies dress  to meet local ethical standards.
 Medical Ethics In The Operating Room

Conclusions & Suggestions

• Preserve Patients’ dignity during all phases of

transportation.
• Patients should not be exposed unnecessarily
regarding:
– The area exposed,
– The duration of exposure,
– The number of people present during exposure.
• Patient examination if needed  should be inside
the operating room only, with privacy & limited
exposure.
 Medical Ethics In The Operating Room

Conclusions & Suggestions

• During patient positioning & preparation 
should only allow those whose presence is
absolutely necessary :

Allow other staff and students in only after

the patient is draped.
(not just for lady patients)
 Medical Ethics In The Operating Room

Conclusions & Suggestions

• The consultant surgeon  is responsible to ensure

all medical staff are aware of & follow the OR
ethical guides (especially regarding female patients).

• The charge nurse of every OR  should have the

authority to limit the number of personnel in the
OR during preparation & surgery especially for
female patients.
 Medical Ethics In The Operating Room

Conclusions & Suggestions

Further work & discussion is still required.