Abstract
In today’s medicine, decisions may not be so simple or unequivocal. The debate forested by scientific development is not alien to the needs of human beings. Now more than ever, new disciplines such as bioethics are gaining relevance in the face of these scientific, technical and biomedical advances that challenge professionals regarding moral and ethical limits. All these uncertainties will be the subject of deliberation and debate. Currently, it is necessary for health professionals to have the necessary tools to reflect and decide on issues such as respect, dignity and the autonomy of people.
Keywords: Bioethics, oral and maxillofacial surgery, reflection
Most international associations of oral and maxillofacial surgeons, define oral and maxillofacial surgery (OMS) as a ‘surgical specialty that includes the diagnosis, surgery and treatments related to a broad spectrum of head-and-neck pathologies’ and has among its purposes to improve the quality and safety of healthcare through the advancement of patient care, education and research in OMS. To this end, the associations will work to promote high standards of education, training, accreditation, research and dissemination of scientific information on OMS.[1]
The term ‘bioethics’ was used for the first time in 1970 by Van Rensselaer Potter, as a proposal for a new discipline that would serve as a bridge, between science and the ethical and moral dimension of the human being.[2] This discipline is considered from three points of view; the academic, since it has the rank of humanistic science and is susceptible to teaching and research, the interdisciplinary nature, which includes the fields of health, healthcare and law and finally the philosophical connection that integrates the critical-rational analysis of morality in the life sciences using a variety of methodologies in a multidisciplinary context.[2,3,4]
In recent decades, there has been a continuous development of scientific, healthcare and research progress, conflicts of interest with the industry, doctor–patient communication relationship and informed consent, which has contributed to great successes in medicine. However, caring for others continues to be a basic need that does not decrease despite these advances, especially in complex pathologies.[3,4]
This is why more and more publications include an analysis of the ethical dilemmas that may arise in the surgeon’s care, teaching and research work. Furthermore, the fact is emphasised that the surgeon’s training must include varied aspects, since he must not only be reliable in the performance of surgery but also reliable as a professional from an ethical and moral point of view.[2,3,4]
In this sense, Beauchamp and Childress, in their work,[5] have described a paradigm that allows for well-founded responses to the complex problems that arise in the development and application of bioethics to human care, universalising a recognised analysis scheme that continues to be useful in helping professionals establish a correct relationship with the health needs of human beings. This paradigm is described in the form of four principles:
Beneficence: It is related to the obligation to do good, that is, it requires a weighing of the risks and benefits so that ‘doing good’ does not only consist of the correct use of the technique, as it also implies a deep respect for ‘the whole’ of the person
Non-Maleficence: Universal principle inherited from Hippocratic medicine, ‘primun non-nocere’, is equivalent to ensuring that the life and health of the person is treated and protected with the maximum attention and care. This principle includes not attacking in all its forms, such as avoiding futility or the use of disproportionate techniques
Autonomy: Refers to the professional’s obligation to respect the values, beliefs and decisions of the patient, expressing their free will through informed consent
Justice: Universal principle that remembers the limitation of health resources, so fair priorities must be established for them.
Some authors use the term ‘surgical ethics’, and distinguish up to five pillars within the moral field of the relationship between surgeon-patient in severe pathologies, such as those related to the patient’s experience; proximity, suffering, rescue and consequences, and on the other hand the fact of the surgeon’s presence throughout the process, as an ethically normative category that will make the difference.[4,5,6] Currently, authors and editors must emphasise recognising the lack of interaction between bioethics and OMS in the literature, remaining only related in the individual and moral sphere of each surgeon.[1,6,7]
This fact may be related to two understandable aspects: On the one hand, the recognition of the as an entity is relatively recent; it will not be until the 20th century, with the development of facial surgical technique, when the need arises to develop a specialty dedicated to a specific area and an orphan pathology. Likewise, it will not be until the 20th century, when bioethics is understood as its own discipline, an essential part of medicine for the safeguarding of human beings against the advancement of science.[6,7]
Although the scientific and technical development of our specialisation is increasing, and numerous research publications, advances in all areas of OMS and new lines of research are described. There are no references, or only superficial mentions, to aspects related to clinical practice and the ethical and moral dimension that should effectively guide the surgeon’s actions during the development of their care or research activity in areas as complex as head-and-neck cancer.[6,7]
The absence of questions related to, ‘how to treat, why to treat and whether everything that can be done is ethical’ is evident; all essential aspects that are fully developed from the integration of bioethics and current evidence-based medicine.[4,5] It is mandatory to remember and encourage that the ethical and moral practice that must guide the surgeon’s actions during the development of his clinical care or research activity, be shown and developed effectively in scientific publications.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
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