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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C. y de la Sociedad Iberolatinoamericana de Columna. SILACO.

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2026, Number 2

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Cir Columna 2026; 4 (2)

Ethical Hospital: only necessary surgeries. Second part

Cortés SJC

Language: Spanish
References: 17
Page: 159-168
PDF size: 237.24 Kb.


ABSTRACT

Unnecessary surgeries represent a growing threat to patient safety, equity in access to healthcare services, and the ethical integrity of medical practice. In specialties such as orthopedics and spine surgery, evidence suggests that a substantial proportion of procedures lack sufficient medical justification, driven by misaligned financial incentives, institutional pressures, defensive medical cultures, and unrecognized clinical biases. This paper presents the Ethical Hospital: only necessary surgeries model, an institutional framework grounded in three core pillars: clinical bioethics, responsible artificial intelligence (RAI), and sustainability. The model is operationalized through four strategic quadrants: 1) what to do more or better; 2) what to reduce; 3) what to eliminate; and 4) what to create anew. Practical tools include collegial review of surgical indications, mandatory institutional second opinions, dynamic consent processes, and clinical-ethical dashboards. These dashboards represent a significant innovation by integrating objective clinical data, bioethical principles, and patient preferences in real time, thereby facilitating transparent shared decision-making. Empirical evidence supports this approach, showing that institutional second-opinion programs can reverse up to 40–60% of initial surgical recommendations, with measurable clinical and economic benefits. The Ethical Hospital model is particularly suited to institutions willing to undergo cultural transformation and provides an ideal ecosystem for the development, validation, and dissemination of more prudent and human-centered clinical practices. Its impact may be amplified through a tripartite university model linking hospitals, academic centers, and technological innovation hubs, allowing the model to scale from a local intervention to a global strategy. Ultimately, doing what is ethically right is also economically viable. Avoiding unnecessary procedures transcends individual patient protection, enhances system-wide efficiency, and restores public trust in medicine. The Ethical Hospital offers a replicable and principled pathway toward a more just, transparent, and profoundly humane healthcare system. To serve is to be more human.


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