What should the surgeon do to demonstrate ethical behavior?
I believe that he should thoroughly discuss the pros and cons of both the Ross operation and the mechanical prosthesis with the patient and also acquaint her with the other alternatives that would avoid oral anticoagulation (ie, aortic allograft, porcine, or pericardial bioprosthesis) to be certain that she is fully aware of all the available options. He should fully describe the relative risks of the two therapeutic options that he is proposing. He should candidly discuss his personal experience and outcomes with the two procedures. He should most certainly offer the patient the option to discuss the Ross procedure with a more experienced surgeon. Most of all, he should consider the welfare of the patient as more important than his own personal interests. There are no clearly established rules that pertain to what is right or wrong in this particular clinical situation. The surgeon must make the decision to act ethically based upon his own moral compass, a clear understanding of the i
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