Abstract

The realities of surgical decision making entail some limits on unbridled autonomy, which can resemble paternalism. The received tradition in bioethics considers shared decision making the gold standard in determining what course of action a patient should take. This chapter examines the various forms of patient–surgeon relationships related to decision making, describes ideal forms of shared decision making, and discusses different approaches in emergent, urgent, and elective clinical situations. The use of decision aids, second opinions, and referrals, as well as fully engaged multidisciplinary discussions, can help the surgeon retain the moral agency that is a requisite component of excellence in surgical practice without devolving into paternalism. The goal is to perform the right operation on the right patient at the right time for the right reasons.