Surgical Conscience or Surgical Convenience ?

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Surgical Conscience or Surgical Convenience ?

• Dr. Nancymarie Phillips, RN, PhD, RNFA, CNOR
• Professor, Perioperative Education Department
• Lakeland Community College
• Kirtland, Ohio

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Foundations for our students

• Definitions
• Introspection of self as the educator
• Assess students status
• Before
• After
• Teach introspection
• Provide examples and scenarios
• Incorporate the concept in routine lessons

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Ethics as a Branch of Philosophy

• Does not have the same meaning for everyone
• Can be influenced by the era and social setting
• Family bonds (monarchy, infidelity, chastity)
• Tribulation (inquisition, crusades, holocaust,
  conquest)
• Career relations (hire, fire, promotion,
  demotion)
• Related to loss or gain
• Personal stance may not be constant in all
  situations

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Definitions

• Professional Ethics
• Expected rules of conduct
• Standards
• Recommended practices
• Guidelines
• Moral choices
• Motivational dynamics
• Philosophy of moral values
• Right vs wrong

• Conscience
• Personal sense of conduct
• Prefer one set of actions over another
• Moral awareness
• Truth and fairness
• Honor
• Judgment and choices
• Part of the superego as relates to psychotherapy

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Confucius said.

• The measure of a mans worth is what he would do
  if he thought he would never be found out.

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Why you do the things you do

• Deontologist
• Do the right thing regardless of the
  consequences
• Self-determination
• Freedom
• Dignity
• Keeping a promise
• Look at both sides

• Consequentialist
• Decision is made based on expected consequences
• Utilitarianism
• Happiness for self and significant others
• For the greater good

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Theory of Conscience

• Motivation behind personal duty
• Rewards and punishments according to perceived
  right or wrong actions
• Desire for justice
• Fear of retribution or rejection
• Reflected judgment of others
• Virtuous self-concept

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Conscience from two views

• Subjective Elements
• Set of common values
• Good or evil motives
• Moral Obligation
• Self-Regulation
• Self-Sacrifice
• Fear of punishment
• Sense of justice

• Objective Elements
• Altruistic actions
• Approval from others with same values good or
  bad
• Open resentment for those who breach common
  values
• Show self-resentment if others observe us
  breaching the values
• Real emotions
• Fake showing of emotions

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How does conscience relate to me?

• As a human person
• Values and beliefs morals
• As a family member
• Obligations
• As a team member
• Role
• As an individual caregiver
• Responsibility

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The Golden Rule

• Do unto others as you would have done to you.
• Treating your patients as though they were part
  of your own body.Not always the easiest thing to
  do.

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The personal enemies of conscience

• Sloth- Laziness
• Indifference- Uncaring
• Avarice (Greed)- Glory-seeking, Power hunger
• Selfishness- Inconvenience
• Anger- Acting out
• Pleasure
• Everett Idris Evans, 1950 Annals of Surgery

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Can we force learned conscience?

• Encourage personal observation of self-action and
  the resultant outcomes
• Observation of the actions of others
• Anticipation of resultant outcomes
• Favorable
• Disasters
• Who is really hurt?

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Teaching Conscience-Building

• Observation of human response
• Evidence-based lessons by example (Hume)
• Relationship between science and reality
• Avoid authoritarianism
• Because I Said so!
• We always do it this way.
• Structuring intellect in the learner
• Critical thinking
• What if philosophy

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What we cannot do as teachers

• Create conscience by threats of punishment
• Strengthen morals by comparison to others
• Convert resentment into respect
• Instill surgical conscience as inherent second
  nature in our students

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Surgical Conscience Reinforcement

• Reality and permanence to education
• Clinical experiences and post conferences
• Applied critical thinking
• Learning by example
• Clinical instructors
• Preceptors
• Discontent with current practices
• Using science and evidence-based practices
• Professional bravery and sparking change
• Opposition from authority

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In conclusion

• Summary points to ponder
• Cultural and ethnic aspects
• Religious influences
• Social constructs
• Professional standards
• Conveniences
• Free moral agent