Ethics and philosophy lecture: surgery…is it an impairing profession?

It has been my privilege to be a Fellow of the American College of Surgeons for more than 30 years, the last 11 of which have been in positions of particular honor, first as a Regent for 9 years, and then as the First Vice-President. The invitation to present the 2001 Ethics and Philosophy Lecture is a joyful culmination to a wonderful journey with this esteemed organization. The American College of Surgeons has represented, for all of surgery and for me in particular, the best of what the profession of surgery has meant to me. It is with this in mind that this lecture is presented with some true concern. It is a concern for surgery in general, and for the American College of Surgeons in particular. In the June, 2001 issue of the Bulletin of the American College of Surgeons, our Executive Director, Thomas Russell, MD, FACS, raised concerns about surgical residencies. Data indicate that fewer medical students are entering surgery, and 68 categorical positions in surgery were unfilled last year, almost 20% of available positions. Medicine in society has changed profoundly in the last 50 years; surgery has changed even more. Residencies have not changed in 100 years. Most of the recommendations to correct this have related to public relations or fine-tuning of residencies. I believe the problem is far more serious and has led to the title of this lecture: “Surgery: Is It an Impairing Profession?” This is the 11th Ethics and Philosophy Lecture. Ten years ago, I was on the committee that, based on the generous gift of John J Conley, MD, FACS, from New York, established this lecture series. Our committee chose Leon Kass, MD, PhD, from the University of Chicago, as the first lecturer. Several months ago, Dr Kass was chosen by President George W Bush to be chairman of a new ethics panel that will oversee the entire subject of research on, and the potential clinical applications of, stem cells. Dr Kass has had a deep and abiding interest in matters of life and death, and his subject for that first lecture was an analysis of the pledge in the Hippocratic Oath, “I will give no deadly drug.” Dr Kass argued that doctors must not kill and that physicians should not be part of patient suicides. Much less, he urged, should we actively end the lives of our patients. It is also a special honor for me to pay respect to Dr John J Conley, an extraordinarily talented surgeon, a surgeon with an abiding interest in esthetic and reconstructive surgery, particularly of the head and neck. He welcomed me when I arrived at the ColumbiaPresbyterian Medical Center in 1978 and was particularly supportive of our residency program in plastic surgery, although he himself, an otolaryngologist, was not a traditionally certified plastic surgeon. Despite what he described as humble origins, he was a man of substantial culture. He was widely read, a patron of the arts, and particularly music. He was also a published poet and I treasure the volumes of his work that he inscribed to me. He would have enjoyed Dr Kass’s lecture, but he would not necessarily have agreed with Dr Kass that physicians should not assist patients at the time of death. Part of his poem, entitled “Right to Die,” from his book, Vocal Painting, Book II 2 argued that we were “denied suicide by mores. . . .”