Medical Ethics In The Operating Room
Medical Ethics
In The Operating Room
a Reminder
Medical Ethics In The Operating Room
Objectives
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A reminder to us all
Why ethics ?
Examples of some existing problems.
Examples of some practical solutions.
Conclusions & Suggestions.
Medical Ethics In The Operating Room
Why Ethics ?
Medical Ethics In The Operating Room
Why Ethics ?
• In medicine we deal with confidential issues
(related directly to people’s lives, history, behavior, body,
health & disease).
• Patients put their trust in medical professionals &
expect high ethical standards.
Medical Ethics In The Operating Room
Why Ethics ?
• Health providing teams are expected to know &
maintain a high level of ethical standard.
• Most ethical issues are standard.
• Some special ethical issues are related to:
– religion, culture, …etc
• Deficiencies in practical application of known
ethical standards exist.
Medical Ethics In The Operating Room
Why Ethics ?
• Ethical issues are always of concern to the public.
• Any breach of ethical standards leaves harmful
effects shaking the confidence in the system.
( media controls the public opinion)
Medical Ethics In The Operating Room
Medical Ethics In The Operating Room
Current Situation
Medical Ethics In The Operating Room
Current Situation
• Written ethical standards:
– ? not widely applied in all hospitals.
– ? not known and/or not fully applied to all personnel
using the Operation Room.
Medical Ethics In The Operating Room
Role of Hospitals
Medical Ethics In The Operating Room
Role of Hospitals
• Provide the best medical treatment as well as
ethical standards.
• Leading hospitals & institutes should:
– Apply the highest ethical standards,
– Teach them to the future generations of medical
personnel.
Medical Ethics In The Operating Room
Some Ethical Issues
In OR
Medical Ethics In The Operating Room
Some Ethical Issues in The OR
I.
II.
III.
IV.
V.
VI.
VII.
Exposure of body.
Dress.
People gathering and traffic.
Noise.
Comments and behavior.
Honesty.
Consent.
Medical Ethics In The Operating Room
I. Exposure of body
Medical Ethics In The Operating Room
Exposure of body
• Parts of body should not be exposed to others
( governed by religion )
– men : from umbilicus to knees.
– ladies : all body.
• Exceptions are allowed when necessary according
to a definite need.
• Exposure of some body parts is often necessary,
depending on procedure.
Medical Ethics In The Operating Room
Exposure of body - Examples
• Preparation for
anesthesia
• Chest auscultation &
inspection.
• Insertion of folly
catheters.
Medical Ethics In The Operating Room
Exposure of body - Examples
• Patient’s transfer to & from:
– Operating table,
– Recovery,
– The ward.
Medical Ethics In The Operating Room
Exposure of body - Examples
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Positioning of patient.
Application of tourniquet.
Cleaning & draping.
Removal of draping &
tourniquet.
• Application of cast.
Medical Ethics In The Operating Room
Exposure of body
Whenever exposure is necessary,
it should be :
• Limited to parts needed only.
• In the presence of limited number of people.
• For the shortest period of time.
Medical Ethics In The Operating Room
Exposure of body –when necessary
• Limited to parts needed only.
Often over exposure takes place !
Medical Ethics In The Operating Room
Exposure of body - when necessary
• In the presence of limited number of people.
Often too many people around
(Drs. / Nurses / Technicians / Students/ workers)
Often unnecessary
Medical Ethics In The Operating Room
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Medical Ethics In The Operating Room
Exposure of body - when necessary
• For the shortest period of time.
• Not to call in the cleaners early (to save time).
Do we really apply this ?
Medical Ethics In The Operating Room
Suggestion
A sign “Female patient” or “Do Not Enter” outside
of the operating room.
Medical Ethics In The Operating Room
II. Dress
Medical Ethics In The Operating Room
Dress - patient
• A single piece,
• Does not expose selected parts only,
• Does not cover well behind, often torn
strip ends,
• Ladies:
– Sleeves short,
– Head, face and neck cover not adequate.
• Not good for both sexes,
Not descent by any standard !
Medical Ethics In The Operating Room
Dress - patient
• Underwear  by some policies should be removed
( even if operation is at neck ! ).
• Problems with patient’s underwear :
– uncleanliness / metal parts / nylon ?
• Solution:
– ensure and allow clean underwear.
– Provide proper disposable underwear .
Medical Ethics In The Operating Room
Suggested Patient’s Dress
Medical Ethics In The Operating Room
Suggested Patient’s Dress
Criteria
• Should provide adequate cover according to
local standards (religion).
• Should provide adequate local (selective)
exposure.
• Should allow quick & practical wide exposure
in emergency situations.
• Should look descent.
Medical Ethics In The Operating Room
Suggested Patient’s Dress
Medical Ethics In The Operating Room
Suggested Patient’s Dress
Medical Ethics In The Operating Room
Suggested Patient’s Dress
Medical Ethics In The Operating Room
Suggested Patient’s Dress
Medical Ethics In The Operating Room
Dress - staff
• Lady staff

Drs., nurses, students.
• Does not meet required standards regarding :
– Design,
– Width & length,
– Areas covered ( head & body) ,
– Practicality.
( ask our lady colleagues ! )
Medical Ethics In The Operating Room
New Staff’s Dress
Suggested and designed by our lady
colleagues
Medical Ethics In The Operating Room
Suggested Staff’s Dress
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Proper head cover.
Proper neck cover.
Proper forearm cover.
Buttons on side.
Wide.
Comfortable.
Medical Ethics In The Operating Room
Suggested Staff’s Dress
• Sleeves can be rolled
up above elbow for
draping.
• Fixed by press button
on strips pulled from
inside.
Medical Ethics In The Operating Room
Lady Surgeons Scrub Area
Medical Ethics In The Operating Room
Scrub Area
Man
Lady
Medical Ethics In The Operating Room
Scrub Area
Medical Ethics In The Operating Room
III. People’s gathering & traffic
Medical Ethics In The Operating Room
People’s gathering and traffic
• Often too many people in the corridors, receiving
area & OR  causes inconvenience to patients &
staff.
• Problem related to :
- behavior of staff & students.
- limited space.
(Both should be discussed & improved)
Medical Ethics In The Operating Room
People’s gathering & traffic
Traffic at the receiving area
Medical Ethics In The Operating Room
IV. Noise
Medical Ethics In The Operating Room
Noise
• Patients coming to OR are worried  need
privacy, silence & reassurance.
• Noise should be kept to minimum.
Medical Ethics In The Operating Room
Noise
Discussions & stories should be in staff
rooms only, away from patients !
Medical Ethics In The Operating Room
V. Comments & Behavior
Medical Ethics In The Operating Room
Comments & Behavior
• Jokes & laughing:
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Loudly,
In front of patients,
In a language not known to them !
Before anesthesia,
During procedure with local/spinal anesthesia.
Medical Ethics In The Operating Room
Comments & Behavior
• Comments & remarks on patient’s:
– Disease,
– Body shape or weight,
– Behavior …etc.
That would not be said if patient is awake
Medical Ethics In The Operating Room
Comments & Behavior
• Patients might see
instruments before
anesthesia:
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Scissors,
Drills,
Scopes,
Saws .. etc
Medical Ethics In The Operating Room
Comments & Behavior
Examining patients
Medical Ethics In The Operating Room
Comments & Behavior
Examining patients
In the receiving area or in the
corridors!
In the OR, in front of others
before or after anesthesia
Medical Ethics In The Operating Room
VI. Honesty
Medical Ethics In The Operating Room
Honesty
• Patients often ask who performed surgery
• The answer should be honest & concentrate on :
– Concept of team work.
– Quality is assured.
– Supervised by the consultant / senior staff.
– Teaching / training does not reduce standards.
Medical Ethics In The Operating Room
Honesty
Tell the truth !
• What went wrong.
• Complications.
• Unexpected incidence.
Medical Ethics In The Operating Room
VII. Consent
Medical Ethics In The Operating Room
Consent
Should not be taken in the operating room !
Medical Ethics In The Operating Room
Conclusions & Suggestions
• Ethical issues are sensitive & important.
• Ethical standards according to religion and culture
 must be met.
• Deficiencies exist in the application of some
ethical standards.
• Need to revise policy of patient’s dress & the
ladies dress  to meet local ethical standards.
Medical Ethics In The Operating Room
Conclusions & Suggestions
• Preserve Patients’ dignity during all phases of
transportation.
• Patients should not be exposed unnecessarily
regarding:
– The area exposed,
– The duration of exposure,
– The number of people present during exposure.
• Patient examination if needed  should be inside
the operating room only, with privacy & limited
exposure.
Medical Ethics In The Operating Room
Conclusions & Suggestions
• During patient positioning & preparation 
should only allow those whose presence is
absolutely necessary :
Allow other staff and students in only after
the patient is draped.
(not just for lady patients)
Medical Ethics In The Operating Room
Conclusions & Suggestions
• The consultant surgeon  is responsible to ensure
all medical staff are aware of & follow the OR
ethical guides (especially regarding female patients).
• The charge nurse of every OR  should have the
authority to limit the number of personnel in the
OR during preparation & surgery especially for
female patients.
Medical Ethics In The Operating Room
Conclusions & Suggestions
Further work & discussion is still required.