Avoiding Patient Abandonment: A Pathway to Ethical Resolution in Situations of Untenable Patient-Surgeon Relationships

Background: A trusting partnership between patient and surgeon lies at the core of a successful therapeutic relationship. However, there are conditions that can jeopardize this partnership and create an ethical dilemma for the surgeon, who is guided by a moral obligation to care for the patient without causing unnecessary harm. We present a discussion of several pathways to achieve ethical resolution to therapeutic relationships that have grown untenable with a focus on patients with comorbid psychiatric illness. The principal objective of these pathways is to prevent further delivery of futile interventions while avoiding patient abandonment. Methods: A review of the literature was performed, and principles of clinical ethics were applied to provide guidelines for care in situations of untenable patient-surgeon relationships. Results: There are no published ethical guidelines for resolving a therapeutic impasse in surgical patients suffering with psychiatric illness. We applied ethical principles of treatment futility, nonmaleficence, beneficence, and patient abandonment to develop a framework for navigating difficult post-operative patient relationships. Conclusions: Managing post-operative surgical patients with comorbid psychiatric conditions presents a unique challenge. In severe cases, therapeutic discharge may be ethically permissible and necessary to disrupt a maladaptive treatment cycle to prevent future patient harm. Specific precautions must be taken to avoid patient abandonment.