title: Ethical challenges in surgery as narrated by practicing surgeons.
abstract: BACKGROUND
  The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations.
  
  
  METHODS
  Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation.
  
  
  RESULTS
  No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues.
  
  
  CONCLUSIONS
  The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.
authors.affiliation: Sør-Trøndelag University College, Faculty of Nursing, Trondheim, Norway. kirsti.torjuul@hist.no.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Torjuul
authors.forename: Ann
authors.initials: A
authors.lastname: Nordam
authors.forename: Venke
authors.initials: V
authors.lastname: Sørlie
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D004992:Ethics, Medical; D013502:General Surgery / Q000941:ethics*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D009664:Norway; D010348:Patient Care Team; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D014342:Truth Disclosure / Q000941:ethics; D035501:Uncertainty
references.citation: Soc Sci Med. 2001 Jan;52(2):171-3
references.pmid: 11144772
references.citation: Soc Sci Med. 2001 Jan;52(2):203-13
references.pmid: 11144776
references.citation: Soc Sci Med. 2001 Jan;52(2):239-48
references.pmid: 11144780
references.citation: Tidsskr Nor Laegeforen. 2001 Feb 10;121(4):495-7
references.pmid: 11255871
references.citation: Soc Sci Med. 2001 Jun;52(11):1719-27
references.pmid: 11327143
references.citation: BMJ. 2001 May 5;322(7294):1073-4
references.pmid: 11337419
references.citation: Br J Surg. 2001 Jun;88(6):769-70
references.pmid: 11412244
references.citation: Soc Sci Med. 2001 Sep;53(5):657-67
references.pmid: 11478544
references.citation: J Am Coll Surg. 2002 Mar;194(3):352-66
references.pmid: 11893137
references.citation: BMJ. 2002 Mar 16;324(7338):624-5
references.pmid: 11895808
references.citation: BMJ. 2002 Apr 6;324(7341):835-8
references.pmid: 11934779
references.citation: BMJ. 2002 Apr 13;324(7342):859-60
references.pmid: 11950716
references.citation: Soc Sci Med. 2002 Apr;54(7):1011-23
references.pmid: 11999499
references.citation: Nurs Ethics. 2002 Nov;9(6):623-35
references.pmid: 12449999
references.citation: Nurs Ethics. 2003 Jul;10(4):388-403
references.pmid: 12875536
references.citation: Scand J Caring Sci. 2003 Sep;17(3):285-92
references.pmid: 12919464
references.citation: Soc Sci Med. 2004 Mar;58(6):1075-84
references.pmid: 14723903
references.citation: Soc Sci Med. 2004 May;58(9):1635-45
references.pmid: 14990366
references.citation: J Med Ethics. 2004 Apr;30(2):160-5
references.pmid: 15082810
references.citation: Soc Sci Med. 2004 Jul;59(1):47-55
references.pmid: 15087142
references.citation: Scand J Caring Sci. 2004 Jun;18(2):145-53
references.pmid: 15147477
references.citation: J Med Educ. 1985 Oct;60(10):804-6
references.pmid: 4045978
references.citation: J Adv Nurs. 1992 Sep;17(9):1028-34
references.pmid: 1401543
references.citation: J Adv Nurs. 1993 Dec;18(12):2008-14
references.pmid: 8132934
references.citation: J Adv Nurs. 1994 Aug;20(2):245-50
references.pmid: 7930141
references.citation: Theor Med. 1996 Sep;17(3):189-207
references.pmid: 8952417
references.citation: Am J Surg. 1997 Dec;174(6):589-91
references.pmid: 9409578
references.citation: Scand J Caring Sci. 1995;9(4):245-53
references.pmid: 8578046
references.citation: Arch Surg. 2000 Jan;135(1):22-5
references.pmid: 10636342
references.citation: Arch Surg. 2000 Jan;135(1):46-50
references.pmid: 10636346
references.citation: Nurs Ethics. 2000 Jan;7(1):47-62
references.pmid: 10703423