Ethics of operative scheduling: fiduciary patient responsibilities and more.

Abstract

You are a vascular surgeon with an arduous operativeschedule in a large private hospital. Your first two casestoday took much longer than estimated, and your thirdcase has been changed to “add-on” status. Your re-mainingpatientisanindigentpatientwithnoninfectedgangrene of the fifth toe and rest pain; he requires afemoral-popliteal bypass within 24 hours to avoid ad-ditional risk. All ORs except the trauma room arecurrently occupied. Staffing drops off with the shiftchange in 1 hour, and afterwards incoming traumapatients will probably delay the start of other cases. Ifyour case is declared an emergency, it will be startednow; otherwise it must wait until a room opens. Nocases are pending in the ER. Tomorrow is your clinicday and your operative schedule is full for the remain-der of the week. What should you do?