Surgeon's role in ethical decisions.

Three clinical cases are summarized to provide examples of reasonably common dilemmas in decision making. Instead of a focus on the solutions, the issue of "who decides" is raised. Contrary to frequent practice, the position is taken that, legally and ethically, substantive patient involvement is required. Factors implicated in physician dominance are briefly discussed, including subjectivity, medical care environments, and notions of the proper role of the physician. Suggestions for the surgeon's role include professional competence, patient education (including effective communication), and separation of the medical/technical aspects of decisions from the ethical/personal ones.