Arthroplasty and Ethics: The Changing-Expanding Indications and Ethical Problems


TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, vol.31, no.1, pp.176-185, 2011 (SCI-Expanded) identifier identifier


Objective: The indications for the arthroplasty applications which provide high patient satisfaction in early postoperative period are pain and function loss nonresponsive to conservative treatment. Frequent emergence of ethical dilemmas is inevitable in these applications where higher success rates appear due to expanded indications of the surgens and patients have higher expectations. In current study, the ethical problems that may be caused from the changing-expanding indications of arthroplasty which is more frequently employed every day were investigated with the basic principles of medical ethics. Material and Methods: The ethical problems that may be encountered in arthroplasty applications caused by the changing-expanding indications are investigated with a four steps ethical analysis approach which is constituted of medical indication, patient's choices, life quality and other elements in the context of the principles of medical ethics. Results: The changing life style in today's world, decreasing tolerance to activity limitation, material design features which develop with technological improvements resulted in application of arthroplasty operations in young and active individuals. The indetermination in the complaints of pain and functional loss increases the physician's responsibility for decision of the operation. The economical, social and professional pressure that are caused by high technology caused ethical dilemmas to increase. In clinical applications, it is impossible to formulate every ethical dilemma, however ethical criteria may be a model to orthopedist for decision. Conclusion: With ethical analysis, not only ethical criteria of clinical application but also the scientific criteria can be evaluated. The patient's choice is as important as the physician's experience, education and training in clinical decision. The effective communication between patient and physician may remove the barriers in priority rankings. Orthopedist should play an active role for conducting this communication. When the preferences of patients who use the possibilities of communication and have biased, wrong or directed information are in conflict with the physician's recommendations, the patient's satisfaction which is the main goal of every orthopedic intervention might not be reached out.