Ethics Debate Tackles the Case of a Postoperative Advance Directive

When patients or their caretakers want to limit the use of life-sustaining technologies after major operations, those limitations may present a challenge for surgeons.

Robert M. Sade, MD

“Some surgeons feel it’s up to the patient to decide how much technology they are willing to accept, while others feel it’s their professional responsibility to do what’s best for the patient, so they are unwilling to accept limitations in advance,” said Robert M. Sade, MD, Distinguished University Professor and Professor of Surgery at the Medical University of South Carolina in Charleston.

Dr. Sade is the facilitator of this year’s Ethics Debate: An Advance Directive Limits Postoperative Care—Should Surgeons Accept Limits on Care? from 12:00 p.m. to 1:00 p.m.
Tuesday in Room 229AB. Constantine Mavroudis, MD and Jeffrey G. Gaca, MD will debate the case of an 80-year-old man with an aortic dissection and associated risk factors. He needs an urgent operation, and it’s likely he will require long-term support with a ventilator and kidney dialysis. His wife is his health care agent, and she has imposed a limit of no more than 1 week of life support after the operation, and then all supportive measures must be discontinued.

Constantine Mavroudis, MD

“I would do the operation and respect the patient’s autonomy and the advanced directives. The possibility of a successful surgery may be low, but it is still real. However, during the postoperative period, I would try to persuade the wife using ethically acceptable means to change her posture and accept further care,” said Dr. Mavroudis, Professor of Surgery at Johns Hopkins University School of Medicine and Site Director of Johns Hopkins Children’s Heart Surgery at the Florida Hospital for Children in Orlando.

Agreeing with Dr. Mavroudis that the patient coming off extubation within a week was slim, Dr. Gaca added that this life-threatening situation dictated urgent surgery, and 1 week was a strict time limit.


Jeffrey G. Gaca, MD

“Patients who want ‘everything done’ oftentimes are not aware of what everything involves. Everything can be tough, painful, and almost cruel and unusual punishment. We have to help patients and their families clarify what their wishes are,” said Dr. Gaca, Associate Professor of Surgery at Duke University in Durham, N.C.

He added that a period of time after the surgery, he would talk with the wife about discontinuing care if needed. “I don’t think we should place limits on this person’s care before going into the operation, but at some point, there is always a limit on care,” Dr. Gaca said.

The Ethics Debate requires a ticket to attend. If you haven’t yet purchased a ticket, you may do so at Registration on the lower level of the convention center.