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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2026, Number 1

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Cir Columna 2026; 4 (1)

Unnecessary surgeries: ethics is a calculation of convenience. Part I

Cortés SJC

Language: Spanish
References: 18
Page: 64-68
PDF size: 213.56 Kb.


ABSTRACT

This narrative review explores the phenomenon of unnecessary surgeries in orthopedic practice from an integrated clinical, ethical, and economic perspective. It examines structural conditions that enable these procedures, particularly in systems influenced by fee-for-service reimbursement models, insufficient bioethical training, and asymmetric power dynamics in physician-patient relationships. Central to this analysis is the concept of "smarmy medical paternalism," a behavioral pattern characterized by the calculated use of empathy to influence patient consent. This form of paternalism exploits informational asymmetries and circumvents evidence-based decision-making, often leading to surgical interventions without clinical justification. Chilean philosopher Gastón Soublette's critique of contemporary ethics provides a conceptual lens: in an era of accelerated information, "true ethics has been replaced by calculation—the calculation of what is convenient." This insight is presented not as a normative proposal but as a diagnostic framework that reveals the disconnect between ethical discourse and actual clinical practice. Empirical evidence underscores the urgency of this issue. Studies indicate that 20-70% of surgical procedures worldwide may be unnecessary. In Mexico, the National Commission of Medical Arbitration (CONAMED) reported 22 formal complaints regarding unnecessary surgeries in 2023, equally distributed between public and private sectors. Spine surgery clinic audits have revealed that up to 60% of proposed procedures lack sufficient clinical justification. These figures highlight systemic overuse that burdens healthcare systems economically while compromising patient safety and autonomy. This article constitutes Part I of a two-part study, providing the conceptual and empirical foundation for the ethical hospital model to be presented in Part II. This model integrates bioethics, digital tools, and sustainable governance to realign surgical decision-making with patient-centered, evidence-based standards.


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