This morning, we had the pleasure of hearing from Dr. Sonia Ramamoorthy, a UCSD Colorectal Surgeon who utilizes innovative robotic surgical techniques, who spoke today about the ethical issues involved in medical innovation. As a surgeon, Dr. Ramamoorthy expressed that while standard of care has a proven track record in many cases, surgical interventions in a diverse patient population inherently brings a bevy of sometimes unexpected intra-operative challenges that must be met with adaptive techniques and innovative thinking. This sentiment of adapting SOP to the real world is something that physicians in internal medicine encounter frequently as well, particularly given that no two patients are exactly alike.
Dr. Ramamoorthy expounded on innovation in the surgical world further, and recounted the a time in UCSD’s recent history, where an interest in natural orificial surgery was gaining popularity internationally. In the time where such surgical techniques were considered “fringe,” or “non-standard,” multiple ethical dilemmas were presented, particularly surrounding whether it was ethical for US physicians to perform such surgeries internationally in countries where the enthusiasm for such unproven techniques was greater. During this time, a surgical team from UCSD, under a temporary appointment with an international hospital, went to perform 25 of such surgeries. The same group then came back performed the first set of transgastric appendectomies in the United States, which then led to a watershed moment for UCSD in the press– an example of when the willingness to adopt innovative approaches can be beneficial.
However, the risk with such willingness to adopt new approaches is the occurrence of acts that transgress major ethical boundaries, such as in the case of the He Jiankui, the Chinese scientist who performed genetic manipulation of human embryos. She went on to explain that in order to systematically consider the risks/benefits of adopting new/innovative approaches in medicine, one must have both personal as well as institutional checklists of questions to ask in order to maintain ethical steadfastness.
Dr. Ramamoorthy explained that the challenges of new technologies are that it must have purpose, identification of winners and losers, must be integrated well, and must have regulatory potential. Questions regarding whether new technologies and techniques should be adopted include an assessment of the population that benefits, who takes the risk, whether the practitioner would utilize the innovation on a loved one, patient preference/understanding. Dr. Ramamoorthy also highlighted a framework to assist in a systematic method of adopting innovative ideas and techniques with the IDEAL framework – idea, development, exploration, assessment, and long-term study.
Finally, she highlighted the need for didactic lessons in ethics in the next generation of medical staff/learners. While such teaching at the moment is not mandatory, the importance of instilling ethical awareness in an era of a “build-it-first” mentality will be of increasingly importance as medical innovation continues to accelerate. We thank Dr. Ramamoorthy for an insightful and thought provoking presentation!