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J Thorac Cardiovasc Surg 2007;133:300-302
© 2007 The American Association for Thoracic Surgery

Editorial

Beyond disclosure: Managing conflicts of interest to strengthen trust in our profession

Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Received for publication September 7, 2006; accepted for publication October 2, 2006.

^_* Address for reprints: Martin F. McKneally, MD, Department of Surgery, University of Toronto, 77 Forest Grove Dr, Toronto, Ontario M2K 1Z4, Canada. (Email: martin.mckneally@utoronto.ca; dmckneally@sympatico.ca).

The first 300 words of the full text of this article appear below.

Cardiothoracic surgeons have competing personal and professional interests that we balance skillfully every day with our obligations to our families, our patients, our partners, and our institutions. Our financial interests in the volatile market of technological innovations have gained recent public attention, as surgeons and institutions participate in the invention and introduction of medical devices.¹ In this editorial, I will try to outline the ethical foundations of our profession’s approach to financial interests and make some suggestions about their management when they conflict with our professional obligations.

Trust binds civil society together. We trust others to deal with us with respect, honesty, and fairness, and we trust them more each time they do so. In a perfect world, we might rely on virtue alone to ensure honesty and fairness. In our imperfect world, standards of conduct and role-specific obligations are defined and legally enforced for those who are entrusted with superior knowledge, power, or authority over others, for example, physicians, scientists, lawyers, government officials, police, and overseers of institutions like hospitals and universities.

Members of our profession are trusted because we maintain high standards. The ethics of surgery—the values and principles that guide us—can be summarized in one word: trustworthiness. We are justifiably trusted to be technically competent and tirelessly committed to assuring that our patients receive the best care we can provide. In the fee-for-service system, we manage the inherent conflict between our financial incentive to perform operations and the interests of patients who may be best served by nonoperative treatment. Almost unconsciously, we follow a well-developed code of virtuous conduct ingrained during residency and reinforced by collegial standards and community respect.

We try to report our clinical and research results honestly, giving an unbiased account to help other practitioners and researchers improve on current approaches to the difficult . . . [Full Text of this Article]