Abstract:
The surgical act involves an asymmetrical relationship, where vulnerability is typically assigned to the patient.
However, surgeons also face ethical, legal and psychological pressures. This double dimension has major
implications for the quality of decisions and the doctor-patient relationship. Evaluating the specificity of the
surgical act through the prism of the concomitant vulnerability of the patient and the surgeon, with an
emphasis on the bioethical consequences of this interaction. A narrative synthesis of open access literature was
conducted using databases such as: PubMed, BioMed Central, DOAJ and CyberLeninka. Articles published
between 2014-2024, in both English and Romanian, were analyzed. Key concepts identified include burnout,
medical error, moral distress and operational stress were identified. The most studies identify the surgeon as
being exposed to acute decision-making stress, institutional pressure and moral vulnerability in the face of
unfavorable outcomes. Surgical interventions on patients with vulnerable status (minors, individuals with
disabilities, terminally ill patients and patients with various infections) highlight ethical dilemmas. Lack of
psychological support, fear of litigation and professional burnout increase the risk of medical errors and affect
professional autonomy. These elements outline a bioethical framework in which the surgeon becomes, in turn,
part of the medical act fragility. Vulnerability is not an exclusive attribute of the patient, but also affects the
surgeon, who faces ethical pressure, emotional strain, and institutional expectations. Acknowledging this reality
may enhance decision-making, strengthen the therapeutic alliance, and reduce burnout risk.
