Response from Dr. Pahl

While researching my response to this ethically driven question, I found a quote from the great French moralist and essayist, Joseph Joubert. He declared that it is better to debate a question without settling it than to settle a question without debating it (Recoil des pensées de M. Joubert, Chateaubriand, Le Norman, Paris, 1838). Upon review of the responses to this question, my ultimate comment is decidedly dichotomous. Before I venture forth with my arguably debatable points, I would like the readers to understand the impetus of this question.

Although I have been in medicine more than 30 years and practicing spine surgery for over 17 years, I found myself learning a new surgical technique. My desire to learn this procedure stemmed from a particular patient who I felt would greatly benefit from this new technique. The patient and I discussed this at length, with him encouraging me to learn and perform the procedure on him, obviously knowing he would be “Patient Zero.”

Upon completing the training, I posed the poll question to one of the teaching surgeons. He emphatically stated, “Absolutely not.” (Out of respect, I will withhold the surgeon's name as it is not relevant for this discussion.) We enjoyed a thoroughly interesting tête-à-tête, as I informed him of my situation in which the patient already knew that he would be the first one for me. (Yes, if you are wondering, I manipulated the scenario much like Captain Kirk in "Star Trek II: The Wrath of Khan" during the Kobayashi Maru test at the Starfleet Academy [orig. Gene Roddenberry & NBC 1966-1969].) I did not choose to take a side as I did not have the firmest grasp on all the parameters of the surgical informed consent which is the legal framework for this question. Additional research was required!

When I could not answer my own question on the ethical points, I found myself asking if our surgical consenting process could more easily answer this question. Ergo, my research extended beyond the unanswered ethical dilemma and rendered it to the legal ramification of the surgical informed consent.

I found numerous medically associated certifying groups, associations, and boards to include the American College of Surgeons, the Georgia State Composite Medical Board (chosen because I hold a license in Georgia), The Joint Commission, and even the US Department of Health and Human Services. While all are great resources with very specific guidelines for obtaining informed consent for surgical procedures, none of them cited any specific situation which this question posed. In short, this question did not have an answer.

The lack of any guidance forced me to dig deeper. My understanding of the informed consent process, which is also stated in some literature discussing the process, is that it has a foundation of what a “reasonable person” would do or want to know in the same situation. I thought, “Eureka, I have a basis to develop a response to this question!” Then, I searched Cornell Law School’s website for the definition of a “reasonable person.” While their website stated it is a legal standard, it still requires the interpretation of a jury of 12 people to determine this legal standard. And, with that statement, their website cited a few famous cases in which there were exceptions to the “reasonable person” (www.law.cornell.edu/wes/reasonable_person). Another roadblock. Ugh.

Beyond this, my only thought was to move beyond human intelligence since it was inconveniently inept. Alas, my last recourse was to ask artificial intelligence. And, when I posed the question to https://chatgpt.com, my response was, “Yes, a surgeon should notify a patient if they are performing a surgery they have not done before.” My thought was immediately, “Wow! Robots!”

So, in summary, I hope my response helps enlighten the readers with this “beyond-worldly” question that it is truly still debatable. However, in synthesizing the answers, it is three to one that a surgeon should explain to the patient the uniqueness of the situation.

My recommendation in this situation is to explain additionally that the surgeon is well-trained in all manners of the surgical area and is extremely comfortable performing the procedure with knowledge, ability, and expertise of performing other surgery if required during the stated procedure were something adverse to occur. But, it is not against any regulatory body to withhold this particular and peculiar information from a patient — artificial intelligence is NOT human intelligence. One might call this a “loophole.”

I hope my response and discussion does not displease the reader. If its dichotomy is not dissimilar to Noah S. “Soggy” Sweat Jr’s famous “Whiskey Speech” (told to a group of Mississippi legislators in April, 1952) then I am not performing my described duties.

Lastly, touché Joseph Joubert. Dr. Stadlan—Further Analysis

Similar to a previously discussed case, a useful metric is “what would I want to know about my surgeon’s experience?” I think that most of us would want to know if this was the first time or two a procedure was being performed by the physician. I think that if there is a likelihood that lack of experience (or other relevant experience) could play a part in a less than perfect outcome, there is an moral obligation to disclose.