Avoiding Patient Abandonment: A Pathway to Ethical Resolution in Situations of Untenable Patient-Surgeon Relationships.

Abstract

A trusting partnership between patient and surgeon lies at the core of a successful therapeutic relationship. However, there are conditions that can jeopardize this partnership and create an ethical dilemma for the surgeon, who is guided by a moral obligation to care for the patient without causing unnecessary harm. The authors present a discussion of several pathways to achieve ethical resolution to therapeutic relationships that have grown untenable, with a focus on patients with comorbid psychiatric illness. The principal objective of these pathways is to prevent further delivery of futile interventions while avoiding patient abandonment. A review of the literature was performed, and principles of clinical ethics were applied to provide guidelines for care in situations of untenable patient-surgeon relationships. There are no published ethical guidelines for resolving a therapeutic impasse in surgical patients with psychiatric illness. The authors applied ethical principles of treatment futility, nonmaleficence, beneficence, and patient abandonment to develop a framework for navigating difficult postoperative patient relationships. Managing postoperative surgical patients with comorbid psychiatric conditions presents a unique challenge. In severe cases, therapeutic discharge may be ethically permissible and necessary to disrupt a maladaptive treatment cycle to prevent future patient harm. Specific precautions must be taken to avoid patient abandonment.