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Code of Ethics
Ethics are moral values. They are aspirations, as well as model standards of exemplary professional conduct for all applicants for certification and all diplomates certified by The American Board of Neurological Surgery. The term neurosurgeon as used here includes all candidates and diplomates.
The issue of ethics in neurosurgery is resolved by a determination that the best interests of the patient are served. It is the duty of all neurosurgeons to place a patient’s welfare and rights above all other considerations. Neurosurgical services must be provided with compassion, respect for human dignity, honesty and integrity.
A neurosurgeon must maintain qualification by continued study and perform only those procedures in which he or she is competent by specific training or assistance with one who is competent. This competence must be supplemented with the opinions and talents of other professionals and with consultations when indicated.
Open communication with the patient is essential. If the patient is unable to understand a communication, the patient’s relatives or other authorized representative should be included. Patient confidences must be safeguarded within the constraints of the law. The performance of medical or surgical procedures shall be preceded by the appropriate informed consent of the patient or the patient’s authorized representative. Timely communication of the patient’s condition to referring and consulting physicians should also be practiced.
Neurosurgery shall be recommended only after careful consideration of the patient’s physical, social, emotional and occupational needs. The preoperative assessment must document indications for surgery. Performance of unnecessary surgery is an extremely serious ethical violation.
Fees for neurosurgical services must not exploit patients or others who pay for those services. In addition, a neurosurgeon must not misrepresent any service that has been performed or is to be performed, or the charges that have been made or will be made for the service.
Delegation of services is the use of auxiliary health care personnel to provide patient care for which the neurosurgeon is responsible. He or she must not delegate to an auxiliary those aspects of patient care within the unique competence of a neurosurgeon (which do not include those permitted by law to be performed by auxiliaries). When any aspects of patient care for which the neurosurgeon is responsible are delegated to an auxiliary, that auxiliary must be qualified and adequately supervised. A neurosurgeon may make different arrangements for the delegation of patient care in special circumstances, such as emergencies, if the patient’s welfare and rights are placed above all other considerations.
Providing a patient's postoperative medical or surgical care until that patient has recovered is integral to patient management. The operating neurosurgeon should provide those aspects of postoperative patient care within the unique competence of a neurosurgeon (which do not include those permitted by law to be performed by auxiliaries). Otherwise, the operating neurosurgeon must plan arrangements before surgery for referral of the patient to another neurosurgeon with the approval of the patient and the other neurosurgeon. The operating neurosurgeon may make different arrangements for provision of those aspects of postoperative patient care within the unique competence of a neurosurgeon in special circumstances, such as emergencies or when no other neurosurgeon is available, if the patient’s welfare and rights are placed above all other considerations. Fees should reflect postoperative medical or surgical care arrangements with advance disclosure to the patient.
Communications to the public must be accurate. They must not convey false, deceptive, or misleading information through statements, testimonials, photographs, graphs or other means. They must not omit material information without which the communication would be deceptive. Communications must not appeal to an individual’s anxiety in any excessive or unfair way; they must not create unjustified expectations of results. If communications refer to benefits or other attributes of neurosurgical procedures that involve significant risks, a realistic assessment of the safety and efficacy must also be included, as well as the availability of alternatives with descriptions or assessments of the benefits and attributes of those alternatives where necessary to avoid deception. Communications must not misrepresent the neurosurgeon’s credentials, training, experience, ability or contain unsubstantiated material claims of superiority. If a communication results in payment to a neurosurgeon, it must be disclosed unless the nature, format or medium makes it apparent.
Neurosurgeons who provide expert testimony in legal proceedings should limit their testimony to areas within the scope of their professional competence and experience. They should express only conclusions or opinions that are supported by or do not go beyond the medical records or the personally performed examinations that form the basis for their testimony. They should not express conclusions or opinions that are influenced or tainted in any way by the compensation they receive in connection with their expert testimony.
Neurosurgeons who are deficient in character or engage in fraud or deception should be identified to appropriate local, regional, state or national authorities. A physically, mentally, or emotionally impaired neurosurgeon should withdraw from those aspects of practice affected by the impairment.