Balancing Objectivity and Humanity: Ethical Challenges and Considerations in Surgical Candidacy Decisions

An essential element of determining surgical candidacy is an accurate understanding of the risks to a given patient. While surgeons remain largely responsible for the selection of their patients, and surgeons' intuition has been shown to be a good indicator of postoperative outcomes, the recent focus in medicine towards minimizing the impact of physician bias has spurred a push towards prioritizing risk assessment tools in candidacy decisions. This has rekindled the debate surrounding what should determine surgical candidacy. Risk assessment tools are proven to be moderately to highly accurate at assessing the risk due to objective and proven risk factors, such as the impact of age or comorbidities. However, they fail to account for the humanity of both the surgeon and the patient and do not measure less easily quantifiable risk factors, such as a surgeon's comfort with a procedure or a patient's health beliefs, when determining risk. In this project, we offer an ethical analysis that highlights these less acknowledged factors. We argue that these factors need to be given greater consideration in risk assessment and surgical candidacy decisions, as they too can affect postoperative risks and outcomes.