Under the leadership of Peter Angelos, MD, PhD, the University of Chicago teaches surgeons how to navigate the ethical quandaries distinct to their field
ON SURGICAL ETHICS BY STEPHEN PHILLIPS
t was supposed to be a routine parathyroidectomy. But, not long into the procedure, the young surgeon found a suspicious nodule in one of the lobes of his patient’s thyroid. Without delay, he removed the lobe and sent it to the lab for analysis. The results were called directly into the operating room: Cancer. The logical next step would have been to remove the remaining lobe. But Peter Angelos, MD, PhD, checked himself. This was not without ramification. There was a small chance the patient, a minister, would be left permanently hoarse. He’d need replacement thyroid hormone for the rest of his life. Would the patient sanction the procedure? It hadn’t been among the contingencies discussed before the surgery. Angelos left the operating room to consult with the patient’s family. The minister’s family was adamant that he wouldn’t want Angelos to proceed — not without discussing it with him first. Angelos was concerned, but heeded the family’s wishes. The minister was thankful Angelos hadn’t pressed ahead. “I told him he needed another operation,” Angelos recalled. “He said, ‘I understand, but I’m glad no one made that decision for me.’” The ultimate outcome of the case — removal, without complication, of the patient’s entire thyroid (albeit after a second operation) — was unremarkable in view of what had been discovered. But more than 15 years later, Angelos looks back on the ethical questions that were posed along the way. As chief of endocrine surgery at the University of Chicago Medicine and professor at the Pritzker School of Medicine, Angelos, 50, is a world-renowned expert in the surgical treatment of disorders of the endocrine organs, such as the thyroid and parathyroid, including cancer. Procedures like parathyroidectomies are his bread and butter. But as the Linda Kohler Anderson Professor of Surgery and associate director of the MacLean Center for Clinical Medical Ethics, Angelos also directs the first program in the nation dedicated to the study of surgical ethics. Each year, under his aegis, the University teaches a cohort of residents, fellows and mid-career surgeons how to navigate Continued on page 16
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