You Are the Perfect Age: An Inquiry into Surgical Ethics during the Arc of a Career.

There is an old saying that history only makes sense in retrospect. I am sure that I am as susceptible to this adage as any other person. However, I will tell the story of my long history as an amateur medical ethicist, which is, to this day, how I would describe myself. My interest in the ethics of medicine, particularly as these ethical principles apply to interventions or procedures, started at a young age, fairly frequently going to the hospital with my father, a General and Thoracic Surgeon. I think that I found myself agreeing to accompany him, when invited, presuming that doing so would be a chance to spend some time with my dad, who was, throughout my childhood, either a surgical resident or a busy practicing surgeon. I will admit that I probably also figured that, at least late at night on the way home, we would stop by some establishment where we could get burgers and fries. However, I will start my reminiscences and reflections on these issues with a more recent story, as it prompted me to think back on my perceptions of those experiences of my youth.

The elephant in the room: ethical issues associated with rare and expensive medical conditions.

The treatment of rare and expensive medical conditions is one of the defining qualities of paediatric cardiology and congenital heart surgery. Increasing concerns over healthcare resource allocation are challenging the merits of treating more expensive forms of congenital heart disease, and this trend will almost certainly continue. In this manuscript, the problems of resource allocation for rare and expensive medical conditions are described from philosophical and economic perspectives. The argument is made that current economic models are limited in the ability to assess the value of treating expensive and rare forms of congenital heart disease. Further, multi-disciplinary approaches are necessary to best determine the merits of treating a patient population such as those with significant congenital heart disease that sometimes requires enormous healthcare resources.

[Guidelines on live demonstrations of thoracic and cardiovascular surgery: pros and cons].

Guidelines on live demonstrations of cardiothoracic surgery were established in Japan following a single incident of an inappropriately performed live demonstration of an open repair of a thoracic aneurysm. Although the guidelines have contributed to ensuring patient safety and privacy, live demonstrations of surgical procedures in Japan have nearly been eliminated due to their strict regulations. However, since the guidelines only apply to surgeons who belong to surgical societies, live demonstrations performed by interventionalists are still performed without following the guidelines. Furthermore, the guidelines regulate both open repair as well as interventional procedures. Some procedures, such as stent graft and laparoscopic procedures, are suited for live demonstrations and some are not, and the guidelines should be tailored to each procedure. At Jikei University, we have held seven live demonstration symposiums with 5,700 participants, of whom 90% provided positive feedback on the value of the live demonstrations. In addition, a survey showed that the morbidity and mortality rates of the 122 live demonstrations performed during this period did not differ from those of similar procedures performed conventionally at our institution, indicating that live demonstration surgery can be performed without compromising safety. If performed by experienced surgeons obeying the guideline, live demonstration surgery is an effective, safe educational tool.