The Program for Surgical Ethics, housed within the Center for Biomedical Ethics and Society in collaboration with the Section of Surgical Sciences, provides the collaborative infrastructure for normative and empirical investigations into ethical issues pertaining to surgical patient care.
Examining Surgical Ethics is important, particularly now, because of the:
- Advances in surgical procedures
- Technological innovations (i.e., robotics, AI)
- Persistence of disparities in access to surgery and in surgical outcomes
- Continued growth of end-stage organ failure and need for transplantation
- The burden of moral distress and burnout on the surgical workforce
Analysis of ethical issues is key to improving more equitable, transparent, access and outcomes of surgical care.
MISSION
Our mission is to support providers in surgery and allied specialties at VUMC in learning about ethical issues in surgery, researching surgical ethics issues, and evaluating ethically-charged surgical practices in order to deliver surgical care in an ethically sound manner.
VISION
To improve quality surgical care by fostering mindful reflection on the context of surgical care.
ENGAGEMENT
Our program offers the VUMC community multiple opportunities to get engaged in surgical ethics:
- Education
- Research
- Application
Our Program aims to improve surgical care, patient outcomes, and healthcare workforce well-being through:
- Setting realistic expectations about surgery
- Enhancing patient-provider communication
- Increasing community engagement
- Increasing patient satisfaction
EDUCATION
- We offer seminars and lecture series on clinical and research ethics in the surgical context through the Center for Biomedical Ethics faculty research program.
- If you would like to be on the mailing list to be notified of upcoming surgical ethics presentations, please email Elisa Gordon at elisa.gordon@vumc.org
- Dr. Allan Peetz leads a General Surgery Ethics M&M on months with fifth Wednesdays at 6am in Light Hall.
If you would like to request a presentation in your Department or Division, please submit a REDCap request here.
RESEARCH
Scholarship in Surgical Ethics
Our faculty and trainees conduct empirical and normative research that addresses a host of surgical ethics topics including:
Surgical Innovation
Informed Consent
Trauma Ethics
Surgical Robots
Surgical Video
Error Disclosure
Surgical Training
Overlapping Surgery
Moral Distress
Our empirical research studies prioritize community engagement in order to ascertain whether:
The ethical issues that surgeons, allied specialties, and academics raise really matter to the community.
Surgeons are aware of ethical issues that matter to the community.
We provide infrastructure to enable interested trainees in the Vanderbilt University Medical Center surgical and anesthesia programs to conduct scholarly work in surgical ethics, including normative and empirical research projects. If you are a medical student, house staff, or faculty interested in surgical ethics, please submit a REDCap service request here to get connected with a research mentor.
Ethics Guidance and Collaboration
The NIH is committed to and endorses bioethics research, as described below:
“Ethical considerations are intrinsic to the conduct of biomedical and health-related behavioral research and the translation of scientific and technological advances into practice. Research addressing bioethical issues can provide data to inform the conduct of biomedical, health-related, and behavioral science research and associated policies. Ethical questions and challenges are interlinked with many of NIH’s areas of scientific priority … The investment in and the integration of bioethics-related research and policy demonstrate NIH’s commitment to advancing ethical research which can facilitate public participation and trust in the research enterprise.” (NOT-OD-25-015)
We provide guidance on research in surgical ethics as follows:
Research Ethics Consultation: Research guidance on ethical issues that arise in the conduct of surgical research. For example, if you are conducting research and would like guidance on addressing the ethical issues arising in that research study, we will be happy to talk with you. This is like a clinical ethics consultation, but this guidance is for a research matter unrelated to a specific patient. For example, research ethical issues may pertain to the following:
Distinguishing between experimental research and clinical innovation
Informed consent for surgical innovations
Protection of vulnerable populations
Ethical use of emerging technology in surgery (robotics, AI, etc.)
Determining equipoise and controls, such as sham surgeries
Exception from Informed Consent (EFIC) Requirements for Emergency Research
Conflict of interest in surgical research
Data privacy and confidentiality in surgical research
Global Surgery and ethical research practices
Ethics of research on vulnerable surgical populations
Managing unanticipated findings in surgical research
Authorship and publication ethics
Surgical Research Collaboration: We can provide scholarly collaboration and/or grantsmanship guidance on ethical dimensions of your manuscript, new or ongoing research study, new grant applications or funded study, etc. We could serve as a co-Investigator and/or co-author, as applicable. Examples of areas of expertise include:
Social determinants of health
Organ transplant ethics
Genetic testing (e.g., APOL1 genetic testing)
Palliative and end-of-life care
Pragmatic trial design
Limited resource allocation
Monitoring and transparency of operating room procedures
Equity in access to surgical care
Diversity and inclusivity in academic surgery
Patient-centered care
Interface of training/education and surgical care
If you are interested in seeking guidance for your research, please submit a REDCap request here. We will connect you to faculty whose research interests match with yours.
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As new articles and books and other resources are published by Center faculty at VUMC on surgical ethics topics, we continuously add citations to this page. Publications are organized by publication year.
- Williams MT, Martin SF, Karlekar M, Ciehl C, Beskow LM, Shinall MC. Patient Perceptions of Specialist Palliative Care Intervention in Surgical Oncology Care. American Journal of Hospice and Palliative Medicine 2024. PMID 38877881
- Liu E, Cid M, Manson DK, Shinall MC, Hua M. Palliative Care Clinicians’ Views on Metrics for Successful Specialist Palliative Care Delivery in the ICU. Journal of Pain and Symptom Management. 2024. PMID 38631650
- Parent B, Thiessen C, Wall A, Levan M, Gordon EJ. A clarified interpretation of permanence justifies death determination in NRP protocols. American Journal of Bioethics. 2024. In Press.
- Peetz AB, Gordon EJ. Resuscitating Lethally Injured Patients: Practical Approaches to Ethical Dilemmas. The Hastings Center Report 2024; In Press.
- Wall AE, Adams BL, Brubaker A, Chang CWJ, Croome KP, Frontera J, Gordon E, Hoffman J, Kaplan LJ, Kumar D, Levitsky J, Minambres E, Parent B, Watson C, Zemmar A, Pomfret EA. The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion. Transplantation. 2024; 4 Feb 1;108(2):312-318.
- Bernat JL, Khush KK, Shemie SD, Hartwig MG, Reese PP, Ave AD, Parent B, Glazier AK, Capron AM, Craig M, Gofton T, Gordon EJ, Healey A, Homan ME, Ladin K, Messer S, Murphy N, Nakagawa TA, Parker WF, Pentz RD, Rodriguez-Arias D, Schwartz B, Sulmasy DP, Truog RD, Wall AE, Wall SP, Wolpe PR, Fenton KN. Knowledge Gaps in Heart and Lung Donation after the Circulatory Determination of Death: Report of a Workshop of the National Heart, Lung, and Blood Institute. Journal of Heart and Lung Transplantation. 2024; In Press.
- Gordon EJ, Lee J, Kang R, Uriarte JJ, Caicedo JC. Disparities Persist Among Hispanic Patients: Completing Evaluation, Waitlisting, and Receiving a Kidney Transplant. Transplantation Direct. 2024 Mar;10(3):31595.
- Mitchell MB, Lin G, Prasad K, Habib DRS, Langerman A. Overlapping Surgery Verbiage in Informed Consent Documents. Ann Surg. 2024 May 6.
- Wall AE, Johannesson L, Reddy V, Warren AM, Gordon EJ, Testa G. Living uterus donors’ perceptions of decision-making and informed consent: A qualitative study of the Dallas Uterus Transplant Study (DUETS) participants. Am J Transplant. 2023 Feb;23(2):265-271.
- Solez K, Gordon E, Farris AB, Cornell L. Open invitation to contribute ideas to a multifaceted approach to ethics in xenotransplantation. Xenotransplantation 2023 Nov-Dec;30(6):e12827.
- Downey MC, Gacki-Smith J, Kuramitsu B, Vanterpool KB, Nordstrom M, Luken M, Langlee W, Riggleman T, Fichter S, Altema W, Jensen SE, Dumanian GA, Cooney CM, Levan ML, Tintle S, Brandacher G, Gordon EJ. Patient Definitions of Transplant Success in Upper Extremity Vascularized Composite Allotransplantation: A Mixed-Methods Study. SAGE Open Med 2023 Jul 13:11:20503121231184677.
- Quach WT, Vittetoe KL, Langerman A. Ethical and Legal Considerations for Recording in the Operating Room: A Systematic Review. J Surg Res. 2023 Aug;288:118-133.
- Gordon EJ, Gacki-Smith J, Kuramitsu BR, Downey M, Vanterpool KB, Nordstrom MJ, Riggleman T, Cooney CM, Jensen S, Dumanian G, Tintle S, Levan M, Brandacher G. Ethical and Psychosocial Factors in the Decision-Making and Informed Consent Process for Upper Extremity Vascularized Composite Allotransplantation: A Mixed-Methods Study. Transplant Direct. 2023 Jul 21;9(8):e1515.
- Makhoul AT, Day RT, Walker JC, Hammack-Aviran CM, Al Kassis S, Winocour JS, Drolet BC. Perioperative Experiences of Transgender Adults Seeking Gender-Affirming Surgery: A Qualitative Interview Study. Transgend Health. 2023;Jun 1;8(3):231-237.
- Vanterpool KB, Gacki-Smith J, Downey MC, Nordstrom M, Luken M, Riggleman T, Fichter S, Altema W, Jensen SE, Dumanian GA, Cooney CM, Levan ML, Tintle S, Brandacher G, Gordon EJ. Patient Preferences of Patient Selection Criteria for Upper Extremity Vascularized Composite Allotransplantation: A Qualitative Study. SAGE Open Med. 2023 Jun 15:11:20503121231181236. eCollection 2023.
- Pillai A, Verna EC, Parikh ND, Cooper C, Thiessen C, Heimbach J, Gordon EJ, Sapisochin G, Selzner N, Mathur A, Perito ER, Jesse M, Liapakis A, Kumar V, on behalf of the LDLT Consensus Working Group. Financial, Policy and Ethical Barriers to the Expansion of Living Donor Liver Transplant: Meeting Report from a Living Donor Liver Transplant Consensus Conference. Clin Transplant. 2023 Jul; 37(7):e14955.
- Hoppenot C, Bryan AF, Wightman SC, Yin V, Ferguson BD, Bidadi S, Mitchell MB, Langerman AJ, Angelos P, Singh P. Surgical informed consent: new challenges. Curr Probl Surg. 2023 Feb;60(2):101258.
- Shinall MC Jr., Ely EW, Diehl C, Beskow LM. Patient Perspectives on Perioperative Supportive Care Needs Surrounding Major Abdominal Operations for Cancer. Annals of Surgical Oncology. 2023;30(5):2597-2605. PMID 36463355.
- Shinall MC Jr., Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Controlled Trial. JAMA Surgery. 2023;158(7):747-755. PMID 37163249.
- Marterre B, Hinshaw DB, Shinall MC. Spirituality in Surgery—A Double-Edged Scalpel. American Surgeon 2023;89(5):1347-1351. PMID 36786501.
- Peetz AB. Does thinking make it so?-what to make of the empirical evidence on moral distress amongst surgeons. Ann Palliat Med. 2023 Sep;12(5):884-886.
- Chotai PN, Kuzemchak MD, Patel MB, Hammack-Aviran C, Dennis BM, Gondek SP, Guillamondegui OD, Meador KG, Wallston KA, Chen H, Peetz AB. The choices we make: Ethical challenges in trauma surgery. Surgery 2022 Jul;172(1):453-459.
- Guidry B, Makhoul AT, Kelly PD, Drolet BC. A Case-Based Curriculum in Plastic Surgery Ethics. Plast Reconstr Surg. 2022 Jan 1;149(1):176e.
- Kelly PD, Fanning JB, Drolet B. Operating room time as a limited resource: ethical considerations for allocation. J Med Ethics 2022 Jan;48(1):14-18.
- Peetz A, Kuzemchak M, Hammack C, Guillamondegui OD, Dennis BM, Eastham S, Meador K, Beskow L, Patel M. Trauma Surgeons' Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation. Am Surg. 2022 Apr;88(4):663-667.
- Murakami N, Baggett ND, Schwarze ML, Ladin K, Courtwright AM, Goldberg HJ, Nolley EP, Jain N, Landzberg M, Wentlandt K, Lai JC, Shinall MC, Ufere NN, Jones CA, Lakin JR. Top Ten Tips Palliative Care Clinicians Should Know About Solid Organ Transplantation. J Palliat Med. 2022 Jul;25(7):1136-1142.
- Lam K, Abràmoff MD, Balibrea JM, Bishop SM, Brady RR, Callcut RA, Chand M, Collins JW, Diener MK, Eisenmann M, Fermont K, Neto MG, Hager GD, Hinchliffe RJ, Horgan A, Jannin P, Langerman A, Logishetty K, Mahadik A, Maier-Hein L, Antona EM, Mascagni P, Mathew RK, Müller-Stich BP, Neumuth T, Nickel F, Park A, Pellino G, Rudzicz F, Shah S, Slack M, Smith MJ, Soomro N, Speidel S, Stoyanov D, Tilney HS, Wagner M, Darzi A, Kinross JM, Purkayastha S. A Delphi consensus statement for digital surgery. NPJ Digit Med. 2022 Jul 19;5(1):100.
- Kumnig M, Jowsey-Gregoire SG, Gordon EJ, Werner-Felmayer G. Psychosocial and Bioethical Challenges and Developments for the Future of Vascularized Composite Allotransplantation: A Scoping Review and Viewpoint of Recent Developments and Clinical Experiences in the Field of VCA. Front Psych: Special Issue. 2022 Dec 15; 13:1045144.
Shinall MC Jr., Bonnet K, Schlundt D, Verma M. Integrating Specialist Palliative Care in the Liver Transplant Evaluation Process: A Qualitative Analysis of Hepatologist and Palliative Care Provider Views. Liver Transplantation. 2022;28(4):678-688. PMID 34743396
- Williams MT, Martin SF, Karlekar M, Ciehl C, Beskow LM, Shinall MC. Patient Perceptions of Specialist Palliative Care Intervention in Surgical Oncology Care. American Journal of Hospice and Palliative Medicine 2024. PMID 38877881
