Exploring what is reasonable ­– uncovering moral reasoning of vascular surgeons in daily practice

Abstract

Abstract Background Vascular surgery offers a range of treatments to relieve burdensome symptoms of pain and ulcers and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to describe and understand vascular surgeons’ moral reasoning in the decision-making process about what is good and right for the patient. Methods Qualitative, semi-structured interviews conducted with 19 vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation. Results The surgeons’ moral reasoning comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included a shift from the blood vessels to a relationship with the patient, a balancing act between the patient’s conflicting needs and a demanding responsibility to make the right decision. The shift from blood vessels to the relationship implied searching within the patient’s health for considerations of what is sensible, justifying authority for surgery through dialogue, and building relationships for mutual security. The balancing act implied weighing independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting present well-being. Finally, a demanding responsibility was conveyed as an urge to remind oneself of the risk of complications, bridling one’s power of proficiency, and managing time during the illness course. Conclusions This study contributes to uncovering the tacit knowledge of how moral reasoning is embodied in the vascular surgeons’ everyday clinical discourse as a tangible part of their daily care of patients. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums for articulating moral considerations in decision-making as well as the fostering of moral character.