medigraphic.com
ISSN 2992-7749 (Electronic)
ISSN 2992-7897 (Print)
Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2026, Number 1

<< Back Next >>

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 delirelationships. 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critique of contemporary ethics provides a conceptual lens: in an era of accelerated information, "true ethics has been replaced by calculation—the calculation of what is convenient."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.


REFERENCES

  1. Weiser TG, Regenbogen SE, Thompson KD, HaynesAB, Lipsitz SR, Berry WR, et al. An estimation of theglobal volume of surgery: a modelling strategy basedon available data. Lancet. 2008; 372: 139-144. doi:10.1016/S0140-6736(08)60878-8.

  2. Guarner V. Las operaciones innecesarias en el ejerciciode la cirugía: un tema de nuestro tiempo con gravesimplicaciones en la ética médica. Gac Med Mex. 2000;136: 183-188.

  3. Comisión Nacional de Arbitraje Médico (CONAMED).Informe anual de actividades 2023 [Internet]. México,Ciudad de México: CONAMED; 2023. p. 9-10.Disponible en: https://www.gob.mx/cms/uploads/attachment/file/907177/Informe-Anual-2023.pdf

  4. Brownlee S, Chalkidou K, Doust J, Elshaug AG, GlasziouP, Heath I, et al. Evidence for overuse of medicalservices around the world. Lancet. 2017; 390: 156-168.doi: 10.1016/S0140-6736(16)32585-5.

  5. Epstein NE. “Evidence of overuse of medical servicesaround the world” By Brownlee et al., Lancet, 2017: Doesthis apply to transforaminal lumbar interbody fusions(TLIF)? Surg Neurol Int. 2019; 10: 154. doi: 10.25259/SNI_386_2019.

  6. Hernández‑Ruiz A, Delgado‑Fernández RI,Mitjans‑Fuentes CO, González‑Volta R. Calidad delos formatos escritos del consentimiento informado enpacientes críticos. Arch Méd Camagüey [Internet]. 2020;24: e634. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=99396

  7. Cortés Sandoval JC. In relation to unnecessarysurgeries: Does it exist smarmy medical paternalism?In: Mansat P, editor. 15th International Congress onShoulder and Elbow Surgery – e‑Posters. JSES Int.2023; 7: 2178. doi: 10.1016/j.jseint.2023.07.001.

  8. Vargas Alvarado E. Intervención quirúrgica falsa: uncaso de incompetencia por deshonestidad. Med LegCosta Rica [Internet]. 1987; 4: 17-18. Disponible en:https://repositorio.binasss.sa.cr/items/f61564ea-1fc2-41e6-9136-c28ec1768965/full

  9. Kannan P, Taheri A, Turkelson CM, Noback PC,Gonzalez MH, Cohen SP, et al. Shared decision-makingin orthopaedic surgery: challenges and opportunities. JBone Joint Surg Am. 2021; 103: 741-748. doi: 10.2106/JBJS.20.01537.

  10. Palazzani L. Informed Consent, Experimentation andEmerging Ethical Problems. BioLaw J. 2019;(1S):11-22.https://doi.org/10.15168/2284-4503-397

  11. Afolabi MO, Bojang K, D’Alessandro U, ImoukhuedeEB, Ravinetto RM, Larson HJ, et al. Multimediainformed consent tool for a low literacy african researchpopulation: development and pilot-testing. J Clin ResBioeth. 2014; 5: 178. doi: 10.4172/2155-9627.1000178.

  12. Guarner V. Incentivos económicos en la prácticamédica: un dilema ético. Gac Med Mex. 2020; 156: 68-73. doi: 10.24875/GMM.20005406.

  13. LoGerfo JP. Organizational and financial influences onpatterns of surgical care. Surg Clin North Am. 1982; 62:677-684. doi: 10.1016/s0039-6109(16)42787-8.

  14. Jarvinen TLN. On patient safety: shoulder “impingement”-telling a SAD story about public trust. Clin OrthopRelat Res. 2022; 480: 1263-1266. doi: 10.1097/CORR.0000000000002262.

  15. Soublette G. La verdadera ética ha sido reemplazadapor el cálculo de lo que me conviene [entrevista dePablo Retamal Navarro]. La Tercera. 2022. Disponibleen: https://www.latercera.com/culto/2022/04/29/gastonsoublette-la-verdadera-etica-ha-sido-reemplazada-porel-calculo-de-lo-que-me-conviene/

  16. Soublette G. La verdadera ética ha sido reemplazadapor el cálculo de lo que me conviene. En: Pastorino M,editor. La crisis ética y cultural [Internet]. SemanarioVoces; 2022. Disponible en: https://semanariovoces.com/gaston-soublette-la-crisis-etica-y-cultural-pormiguel-pastorino/

  17. McMillan J. Comparison of interactive electronic versusstandard document method for obtaining patient informedconsent [Internet]. Houston: UT School of Public Health;2020. Available in: https://digitalcommons.library.tmc.edu/uthsph_diseertsopen/123

  18. Laitinen A, Sahlgren O. AI systems and respect forhuman autonomy. Front Artif Intell. 2021; 4: 705164.doi: 10.3389/frai.2021.705164.




2020     |     www.medigraphic.com