Thoracic Surgery Considerations in the Mentally Ill or Handicapped Patient.

Increasing prevalence of mentally ill and handicapped populations requiring surgical thoracic interventions has brought to light their worse associated morbidity and mortality. Baseline functional status, caretaker environment, and mental limitations in day to day life have an impact in the short and long term from these interventions. Aggressive perioperative care, multispecialty approach, technical aspects, palliative procedures, and ethical considerations all play a part in improving outcomes. In this article real cases are presented illustrating points of care and situations for discussion.

The American Association for Thoracic Surgery 2016 ethics forum: Working virtues in surgical practice.

Moral virtues are the complement to ethical principles. They constitute the elements of character that drive habits and daily routines. Certain virtues are especially important in surgery, shaping surgical practice even when no big decisions are at hand. Eight virtues are described and the work they do is explored: trustworthiness, equanimity, empathy, advocacy, compassion, courage, humility, and hope.

Whole organ and tissue reconstruction in thoracic regenerative surgery.

Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.

Quality of life and ethical concerns in the elderly thoracic surgery patient.

The diversity of older patients presents a challenge when deciding whether to recommend thoracic surgery to an individual. Comparable postoperative morbidity and mortality between younger and older patient groups indicate that surgeons are skilled in determining which older patients are most fit for surgery on the basis of comorbidities, performance status, and QOL. Criteria for the inclusion of older patients in thoracic surgical trials have not been described, however. As newer, minimally invasive techniques and limited resections are incorporated into elderly patients' care, criteria for inclusion must be evaluated prospectively in trials designed to establish risk factors for morbidity and mortality in elderly patients traditionally excluded from surgery. In addition, QOL needs to be evaluated specifically in the elderly, and meaningful comparisons need to be made with other elderly patients who do not undergo surgery. Finally, to inform better the ethical debate about whether thoracic surgery benefits a patient of advanced age, longer-term QOL and functional outcomes need to be evaluated. The ethical challenge is finding a delicate balance: on the one hand, avoiding ageism and providing a therapy to older patients that offers the only meaningful chance for improved survival, especially in early-stage disease, and on the other hand, avoiding overzealously providing a therapy with significant morbidity and mortality to older persons who are already at greater risk for functional loss and death.