The specificity of the surgical act: vulnerable patient versus vulnerable surgeon

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.