The ethical dilemma of a heart surgeon | Ferdinand R. Waldenberger | TEDxKlagenfurt
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- เผยแพร่เมื่อ 26 ต.ค. 2015
- Ferdinand Waldenberger is a highly respected heart surgeon. On stage he perfectly describes what it feels like to carry the responsibility for another person´s life. He also gives valuable advice for those who want to heal on a clinical level and demonstrates that the line between bravery and stupidity can sometimes be very thin.
Maybe some of you might know the expression “To hold someone´s heart in your hand”. It is hard to imagine what it must feel like to be responsible for such an important organ. Ferdinand Waldenberger is Cardiac Surgeon, Associate Professor and Medical Director. Today he is Hospital Director at the Clinical Center in Klagenfurt. It is part of his job to handle dangerous and risky operations. He was part of the team for the first heart transplantation in 1984 and the first to successfully fulfill a heart transplantation on a newborn child. On top of that Ferdinand teaches at the University Steyr and the Medical School in Vienna.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at ted.com/tedx
Imagine how difficult it must be to deeply explain the intricacies of heart surgery in a foreign language. Damn.
All heart surgeons have my utmost respect! 2 heart surgeons have saved my life twice in the last 25 years of me being here. Once at 3 years old in 1996 and once in 2015 only three years ago. I was put on a machine that controlled my blood flow and breathing and my heart was stopped to be repaired, after coming out of the operation, my body was as cold as a deceased corpse. I woke up in a foil blanket and lots of needles in my body, including neck and arms, 3 plastic tubes coming out from above my belly button. If it wasn't for the 2 heart surgeons and the Freemans hospital in Newcastle UK, I wouldn't be here to type this comment. Surgeons should be on the wages of football players, and football players should be on surgeons wages. Surgeons are saving lives DAILY, footballers kick a ball.
But then, eat correctly, so that one doesn't even need to consider surgery: No animal products, high nutrient organic plant foods, no oils (huge mistake, and still recommended), no sugar , no processed foods...these are thee link to heart problems...eat well, but all good plant foods, but also not too much...we kill ourselves with poor diet, and not good exercise............these things keep you from even having to see this guy at all...you'd never even run into him (unless at the gym!)
onefoot7 he said he needed hearth surgery at the age of 3, i don’t think that’s because of a bad life style
@@superalvin7208 for real that comment should be downvoted
@@superalvin7208 well said! I inherited a gene from my father which caused my rare form of heart failure. I always lived healthily. But soon I’ll need a transplant.
My mom had Thyroid cancer last year. Without the modern medical technology, she would have been dead. Thank god we live in such a great time.
Medical professionals like this man give me hope. So incredibly happy he gave this talk.
But then, eat correctly, so that one doesn't even need to consider surgery: No animal products, high nutrient organic plant foods, no oils (huge mistake, and still recommended), no sugar , no processed foods...these are thee link to heart problems...eat well, but all good plant foods, but also not too much...we kill ourselves with poor diet, and not good exercise............these things keep you from even having to see this guy at all...you'd never even run into him (unless at the gym!)
@@onefoot7 Iam sorry but some of the information you have posted is completely wrong.
Agreed, it is great to see there are still physicians and other health care professionals willing to embody risk to themselves for the lives of their patients. The unfortunate reality now a days, at least in the U.S, is that many surgeons are forced to stat pad a lot of their surgeries due to the high risk of being sued, fired, or disbarred from medicine. Heart surgeons depending on their specialty will spend 4 years in medical school, 4-6 years in general surgery, and then another couple years doing a cardiac fellowship after that. They take on huge amounts of debt, working ungodly amounts of hours, working tirelessly to even get to the point where they are called upon to be in these situations the speaker is describing. Then at the end of that road there is this huge risk of losing your reputation, your job, or your overall wellbeing if you let a patient die. It takes a lot of courage to make the decisions the speaker is discussing now a days, and it aligns with the ethical principles of beneficence or doing good or right by your patient regardless of the circumstances. There are a lot of things to consider in a very short window during surgery such as: “does this decision fall within the informed consent?” “How will this patients quality of life be if I decide to save them after this complication?” “Am I saving this person for my own sake, or for theirs?” These are tough moral questions that need clear cut answers prior to taking any action. The speaker does a good job of emphasizing that. If you want another interesting speaker about these topics check this out: (269) Ethical Dilemmas in the ICU - TH-cam
Dr. Waldenberger gives a great insight into the thought process that a doctor goes through in the care of their patients. In medical ethics there are two concepts that I believe that Dr. Waldenberger touched on quite well. The first of those being nonmaleficence, which is the intention of avoiding harm or injury to others and second being beneficence, which is promoting the well-being of others. His story about discussing with his patient a new procedure to operate on an aortic aneurysm that he felt would greatly benefit them, to which the patient consented, and the surgery was performed successfully was powerful. He added that performing this procedure was in conflict with the system of the hospital and he almost lost his job even though the patient lived and benefitted from the surgery. To me, this shows a physician that has true compassion and genuinely wants the best for his patients. He knew that this new procedure could be a major benefit to the well-being of his patient and put his job on the line to give them the greatest chance for successful treatment. This is a great example of promoting the well-being of others. Another interesting point that Dr. Waldenberger brought up is that sometimes the most state of the art procedure or treatment approach may not be in the best interest of a patient. He shared another story about his mother going to the hospital with trouble breathing and his decision process on whether to put her on a respirator. His ultimate decision to put her on the respirator came down to whether doing so would make her more comfortable and the fact that she would be miserable and suffocating without it. He discussed that a treatment route needs to be picked that causes minimal harm and maximal benefit for the patient. That could mean performing the cutting edge, state-of-the-art surgery or treating the patient conservatively. I feel that this approach to patient care also gives autonomy to the patient because they are able to proceed with what treatment option align with their personal healthcare goals and desires. A patient may not be interested in going through with an invasive surgery and the recovery process that follows even if there is evidence that doing so would be a great benefit to them. There has been a recent push in healthcare to switch from a doctor vs patient mentality to a patient first one. As more physicians are trained in this patient first approach and it is adopted into how they practice medicine, I am sure that we will see increased levels of patient satisfaction with their physician and with their overall care. As physicians open the door for patients to comfortably speak about their personal health goals and allow them to take part in deciding what treatment option is best for them, I am sure we will see an increase in patient compliance as patients feel their doctor has their best interests in mind.
What a wonderful speech, I loved it! As a current medical student, it really left me thinking a lot about my future patients and those who I will be potentially serving in the future. I really appreciated his mention of the importance of having educated courage. As I think about the many decisions I have made in my own life, I am left wondering what decisions were made courageously? What decisions were made with educated courage? I do feel like these are two different things. Courage alone may involve doing something out of your own comfort zone. Educated courage has more depth and more purpose in why you choose to be courageous. Educated courage, I feel, dips heavily into the importance of ethical decision making when helping a patient. Of course there will be very difficult situations you will find yourself in as a physician, especially a surgeon, but using your own education, and a background of knowledge to guide you in the decision I feel is the most courageous thing you can do for your patient. Do no harm. Focusing on doing only good for our patients should be the goal. The field of medicine is unique in that being courageous may also involve risk for the patient, so this should definitely be a shared decision making process! Again, I truly appreciate this speech, as it has opened my eyes and understanding to a new outlook on medicine.
I really appreciate that Dr. Waldenberger's approach is heavily invested in the medical pillars of beneficence and nonmaleficience with doing what is right in the moment based on evidence-based findings and calculating the risk it would take to either perform a procedure or do nothing. One thing that sticks out to me about his lecture is the idea behind "asking forgiveness and not permission" for the sake of saving a patient. Medicine universally follows four pillars that essentially maximize benefit, reduce harm, and treat all patients equally. However, I am curious how his healthcare system approaches patient-care interactions regarding informed consent and the use of potential experimental procedures in the middle of surgery.
In the United States, surgeons like Dr. Waldenberger have unique responsibilities and privileges that are quite different from other providers that are not exposed to the same environments as surgeons are. Some of the most notable responsibilities include facing the challenges of working in ways that increase risk based on patient preference, disclosing the role as the attending of multiple concurrent surgery cases during procedure, and disclosing the experience when it comes to surgical innovation (Lo 2019). Reflecting on Dr. Waldenberger’s experience regarding saving a patient with a new innovation while the patient was actively dying, I thought about how it is common practice for physicians in the United States to disclose the use of experimental procedures as an alternative, but I have never heard of experimental disclosure if the patient decompensated during the previously agreed upon procedure.
Even though some may argue that this action could be a violation of autonomy, I would still stand with Dr. Waldenberger's decision of ethical judgement. I believe Dr. Waldenberger’s actions were ethical due to his use of the four pillars of medical ethics with his philosophy of educated courage under the assumption that his patient wanted to live regardless of the procedure type, but I think patient autonomy could be at risk if informed consent is not expanded upon. I believe that all healthcare providers should within reason adapt from Dr. Waldenberger’s style of practice, but I do think the United States healthcare system may need to consider involving experimental procedures in the middle of procedure as a part of informed consent in order to preserve patient autonomy and provide quality care.
Citation:
Lo B. Chapter 38: Ethical Issues in Surgery. In: Resolving Ethical Dilemmas: A Guide for Clinicians. 6th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2019:276-283.
Dr. Ferdinand Waldenberger was able to bring up many ethical dilemmas faced from surgeons-more specifically cardiac surgeons. It was amazing to hear his perspective about risk taking along with the ethical considerations that he himself has had to make throughout his career. With being on the team for the first transplantation-he brought up the point that there was no risk to him. It was never achieved before-but rather there was a tremendous amount of risk to the patient. As a medical student about to go off on clinical rotations-surgery being one of them-this is something that has always been on the back of my mind. How moving forward my actions and decisions will impact my patients either positively or negatively. Dr. Waldenberger in this talked emphasized some key ethical principles that we have been learning about in our medical school ethics class which is beneficence and non-maleficence. As physicians it is our job to not necessarily do the best procedure or in this case surgery-but rather take into consideration our patient, their comorbidities, and then decide what surgery will be the best for this patient doing the least amount of harm. He discusses some situations where he had to think within seconds and his decisions were the difference between life and death in these patients on the operating table.
Another thing that really opened my eyes and perspective in medicine is how the outcome determines whether or not our actions were justified or as Dr. Waldenberger puts it “foolish”. He discussed how he was considered to be “brave” for his actions but in the back of his mind he stated he was only doing what was considered to be best for that patient-even if it means being in the operating room for 12+ hours. Dr. Waldenberger states how if he didn’t take those risks or if he did not have certain medical resources how the poor outcome would justify his actions of being “foolish” and raise ethical concerns as him trying something so risky to save the patient would be going against beneficence.
Not only in surgery do physicians need to be fast acting to the situations at hand but any specialties may run into a high stress situation where they need to think on their feet-depending on the outcome their actions could raise ethical concerns-however, I believe if we always practice with our patients best interests in heart we will be able to avoid ethical dilemmas-even with unfavorable outcomes as we did what we could for our patient.
Thank you Dr.Waldenberg,you are great!What a wonderful talk!I am a 7th year cardiac surgery resident and i would like to comment that i think that a cardiac surgeon needs support from a good team,from the hospital he works...it is very difficult to maintain your courage,your motivation especially when there are bad behaviors and negative mood at the operating room..I do not know what someone can do about that..Great to listen you Dr.Waldenberg
But then, eat correctly, so that one doesn't even need to consider surgery: No animal products, high nutrient organic plant foods, no oils (huge mistake, and still recommended), no sugar , no processed foods...these are thee link to heart problems...eat well, but all good plant foods, but also not too much...we kill ourselves with poor diet, and not good exercise............these things keep you from even having to see this guy at all...you'd never even run into him (unless at the gym!)
Dr. Joel Fuhrman, MD....better than a surgeon anyday!!!!!
Dr. Waldenberger has some incredible unique expereineces and thus a very unique perspective on the ethical dilemas that exist not only in heart surgery but in medicine as a whole. The cases he presented in this talk highlight how stressful it can be to make the right choice when it comes to the treatment and care of your patients, especially those in critical condition. As a medical student we have an ethics class where scenarios similar to those experienced by Dr. Waldenberger are discussed and the course of action is often debated for more than an hour without anyone able to come to a final decision and what is the best course of action.
There exists a pillar in medical ethics that has the name of non-maleficence or the obligation to not inflict harm on others. This is similar to the Hippocratic oath that we take as physicians to first do no harm. This is the fine line between bravery and stupidity that Dr. Waldenberger mentioned in his talk. On the one hand when his procedures did work even though they were risky they were an educated risk and he was, I’m sure, often praised for the outcome. However, if for whatever reason one of these educated risks had gone awry then we might all have been introduced to Dr. Waldenberger in very different circumstances. This is where the ethical discussion gets complicated because had he done nothing or not taken drastic risks with some of his patients, they may have died instead of lived thanks to his decision to ride the line.
What makes these situations even harder is that the patient often does not have much say in the matter, when they are lying on the table unable to use their agency or autonomy to handle the situation. This is a difficult decision to make in any situation especially surgery, even a primary care doctor has to make tough decisions occasionally regarding the care of a patient but the patient usually has the capacity to aid in those decisions. Luckily this is why the medical field has created so many various checks and balances within the system to help aid not just the physician in making a decision but making sure the patient is aware ahead of any procedure what the risks might be and what actions might need to take place. With a situation like this I do not think Dr. Waldenberger acted wrongly but I wonder what I would do if placed in the shoes of the patients or the family of the patients that he treated in a drastic measure at the last second.
I really appreciated this Ted Talk and the insight Dr. Waldenberger provided with insight into some of the decisions heart surgeons have to make on a daily basis. Some of the talking points that really resonated with me is when he described the fine line between stupidity and bravery. If you make decisions without thinking of the consequences and for an ulterior motive, that is a foolish decision. If you do things in a calculated way in which you weight the cost and benefits first, that would be considered bravery. Dr. Waldenberger explained that doctors and especially surgeons have to have participate in educated courage because a lot of the times it is easy to lose sight of the fact that the decisions they make carry no risk for they themselves, all of the risk is on the patients. A lot of the decisions surgeons make have to be in a split second so being able to do so while also consider all of the various ethical tenets like beneficence (providing the best care for the patient) and nonmaleficence (trying to prevent harm). Surgeons must make these decisions because the patient is unable to be involved in the process and unable to uphold their autonomy which patients know going into any kind of surgery. Dr. Waldenberger highlights that this is the nature of working in the medical field, being responsible for another person’s life can be difficult especially having to remain unbiased and try to think of things from a logical standpoint versus a purely emotional one.
One thing that this talk made me think about that I wish Dr. Waldenberger could have included in his discussion is that not all surgeons or doctors have to make these huge decisions alone. A lot of the time doctors can consult with fellow physicians that may specialize in various areas of medicine to have another educated opinion regarding their patients conditions. Also many hospitals have ethical review boards for cases that are more challenging to approach as the “right” decision may not be as clear cut. The collaborative nature of medicine allows some of the burden to be taken of just one physician having to make major decisions about their patients. However, with some of the cases that Dr. Waldenberger discussed it seemed that he did not have the time nor staff available to consult with others to try to talk through the different options the patient had. Also it may not be feasible for situations where a decision has to be made so quickly with the patient’s life at stake. Overall, this opened my eyes as a current medical school to situations I may run into and how to approach these ethical dilemmas.
what a wonderful surgeon and human being he is...delighted to get opportunity to listen him .
Dr. Waldenberger’s talk is quite powerful. I found his discussion about educated courage most interesting. I think he explains it perfectly! In the healthcare profession doctors take ethical oaths they must uphold, one in particular being nonmaleficence. This means do no harm. When Dr. Waldenberger discusses educated courage doctors are walking the fine line of nonmaleficence. This I can imagine is one of the most difficult decisions a doctor has to make. When do they decide to treat a patient outside the norms of standard practice in attempts to save a person’s life without doing it in a way that causes more harm. I believe this is a learned skill that overtime doctors get better at but is never going to be perfect. It is very easy to be on the outside looking in and judging what a doctor does and does not do after the fact. It is much harder to put yourself in their shoes in the heat of the moment. I think if doctors allow their decisions be guided by the ethical principle of nonmaleficence they can have what Dr. Waldenberger describes as educated courage and not have to worry about am I doing wrong.
I also agree that Dr. Waldenberger’s talk was quite powerful and especially enjoyed his concept of “educated courage”. As physicians, we must uphold the four ethical principles: 1) respect for autonomy, 2) beneficence, 3) non-maleficence, and 4) justice. When physicians are put in similar situations like Dr. Waldenberger, where they are under high stress in a challenging situation with limited time and equipment, I also imagine it must be very difficult to make decisions like Dr. Waldenberger did. Thus, I believe his term “educated courage” perfectly reflects his actions. However, I don’t believe that non-maleficence was the only ethical principle that was up for debate in these situations for Dr. Waldenberger. I believe that I can argue that beneficence was also at play in these situations. Dr. Waldenberger was more likely motivated by beneficence, the idea to remove harm and promote good in these situations, which made him act in a way to save his patients’ lives. I feel that if non-maleficence was the only ethical concept at play then Dr. Waldenberger would be less likely to act the way that he did due to fear of causing harm to the patient. However, Dr. Waldenberger’s decisions were made with hopes that the benefits would outweigh the risks and that the patient would get better rather than get worse. I’m also not sure if this concept of “educated courage” is a learned skill that physicians learn overtime. I feel that it would depend on the person. I can see how with more knowledge and experience, brings more confidence. However, I also believe that it depends on the individual to be quick and innovative under a time and possibly material constraint. Thus, I don’t believe that the concept of “educated courage” is a skill that can be learned overtime.
Dr. Waldenberger’s analysis of bravery versus stupidity being on a spectrum was absolutely fascinating to me. Each term comes with its own inherent connotations, but both concepts can arise from the same situation in focus. A major theme throughout the discussion was the analysis of risk in any given scenario, whether that be on the operating table or throughout various daily life events. Risks are inherent in life, especially in the OR, and it is evident that this man’s mind is constantly working to assess these risks and provide the best care possible to the patient. Most people would agree that blindly going forward on an uncharted path without knowing what will happen could be seen as foolish or as courageous, largely based on the outcome. However, in the lens of an operation that has the opportunity of saving a human being’s life, this decision should be heralded as a clear demonstration of beneficence. Dr. Waldenberger’s choice to perform the procedure which prevented the patient from passing was not for personal edification. It is clear to me after listening that the intention was filled with hope of a positive outcome, devoid of any maleficent intent. The doctor’s other anecdotes of triumph and perseverance were further examples of how giving up and accepting defeat would lead to certain death for the patient. If this path was chosen, which would have a known albeit poor outcome, I would argue that this would be demonstrating the ethical tenet of maleficence. Foolishness would be making a decision with a disregard to the risks to the patient that may be completely avoidable. Sure, there are some procedures that will be futile to continue and would only be wasting further resources and providing no further benefit to patients. With this in mind, having the wisdom to know when to stop treatment is what allows a physician to make educated decisions without jeopardizing ethical and moral principles in the process. The decisions that were made throughout Dr. Walbenberger’s discussion utilized calculated choices that sought to benefit the patient’s well-being, which is a key aspect of a high-quality physician.
He was VERY nervous, clearly. Perspiring like crazy. But why a great presentation. I, like is all, have a special kind of supreme admiration and respect for surgeons. The way they can open someone up and literally, physically fix them with their hands and tools.
I would like to start this off by saying thank you to Dr. Waldenburg for giving such a moving speech. Dr. Waldenburg speaks about calculated risk from an expert physician’s perspective, which is a really good point because it is difficult for these algorithms to take into account the expert physician’s experience. It is impossible for an algorithm to know what it is like to “hold a heart in your hand”. So when discussing the concept of risk we have to ask ourselves if the computers can take into account beneficence, non-maleficence, and justice for the patient. I really enjoyed your reference about bravery versus foolishness. In my medical ethics course, every topic we discuss can be boiled down to making decisions based on these three aforementioned principles.
I, respectfully, do not believe that an algorithm is capable of keeping the best interest of the patient “in mind”. Rather, these algorithms are designed to simply protect the patient and more importantly the physician and the hospital. I think that an algorithm embodies two of the three ethical principles, non-maleficence and justice, yet I would not consider it beneficent. My reasoning is that in order to embody beneficence, the algorithm must desire to promote the most good for the patient, but an algorithm is incapable of creating a dialogue with a patient to discover this. However, to the tool’s credit, it does not promote harm, as in, it does possess the capability of non-maleficence. I think that through this ability the patient is done a certain amount of justice because a physician can relay to the patient the meaning of what the risk is for a procedure. Thus the patient is aware and can make a logical decision. In this fashion I could see the algorithms being beneficent, yet that it a whole other discussion. In closing I would simply like to state that this was a great talk and thank you for sharing your knowledge. I know my discussion is a bit “nit-picky” however this is what stood out to me. I hope in the future we develop technologies that are able to embody all three of these ethical principles. Thank you for reading.
And this is why I am not a heart surgeon. I listen to him deciding whether to go back and redo an older patient's operation that may not work out. I would have been way too tired I think and I would have figured this patient is old anyway, it's they're time. That is why it's a calling to be a surgeon, that only the very best are accepted. Thank God!
: Dr. Waldenberger you are amazing for your courage in all the difficult decisions you have had to make throughout your career. I too agree that when our backs are against the wall, and we find ourselves in moments where we are not able to calculate the risks that if we trust in our morals and have the patient’s best interests at heart that we can accomplish amazingly difficult things. I do worry for physicians who do everything in their power to help the patient but still fall under scrutiny. Like the Dr. explained how in order to save a life he almost lost his job. Circumstances like this place physicians in ethical dilemmas and while cases like this are rare, they still occur today, especially in leading fields. Is every physician willing to place their career on the line in order to save a life? Sadly, I don’t think that every doctor is as courageous and brave. Listening to him talk about his career helped me to understand that each scenario was so unique. We often try to draw ethical lines in the sand for what is right and what isn’t. Each of his experiences were approached with different ethics; in one case he took extreme measures and limited resources to keep a patient that was undergoing a minimally invasive surgery alive without patient consent, in another he performed a relatively new and unapproved surgery to save a patient which nearly cost him his job, and lastly he had to know when to no longer take action with his mother and when it was time to let her go. Each of these cases show great amounts of courage. While they were all different, they all had the patients’ best interests at heart. I do worry with the world that we live in that physicians like this good doctor will fall under increasing pressure to conform to institutions to protect the interests of the hospitals and insurance companies. Medicine is always changing and as it continues to change it seems doctors are facing harder decisions when their backs are up against the wall because the increasing legal pressures. Hopefully, the patient’s best interests can remain the forefront of our ethical decisions and not let them be swayed by insurance or hospital giants' interests.
I feel for this guy so much... You can tell he's seen some really haunting things over his years of surgery...
Dr. Ferdinand R. Waldenberger is an accomplished and (self) honest cardiac surgeon--and man. I appreciate his presentation.
Dr. Ferdinand, you're an super hero.
Love from India :)
Dr. Waldenbergeer's story about the elderly patient he worked with brings up a good point about the ethical dilemma physicians can often find themselves in. When he re-perfused the patient and they started bleeding everywhere, that was not a good sign and a decision had to be made by the physician. Let the patient die, or try the operation again, prolong the surgery, and increase the risk. Providers are under an ethical obligation to do good for the patient as well as do no harm. In this situation, doing “good” could potentially also cause the patient harm. I think deciding to continue the operation and keep trying to save the patient was the right course of action. Yes the surgery would be longer and the risks higher, but in my opinion, risks associated with surgery are a better alternative than certain death. Dr. Waldenberger said, “It is better to ask for forgiveness than permission.” A statement that could potentially have some immense adverse effects on the society we live in today. But a statement I agree with. People can find fault in anyone for anything, so if a doctor is truly trying to do what he thinks is best for his patient, I can’t foresee the consequences of those actions being too severe. On a separate note from my ethical viewpoint, I appreciated how Dr. Waldenberger approached the topic of death. He said that in the age of modern medicine, we can do just about anything, but that does not always mean that we should. Sometimes we must “let mother nature win”. I completely agree, there comes a point where preserving an individual’s quality of life is more valuable than lengthening it.
Dr. Waldenberger said it perfectly when he stated that “the line between stupidity and bravery sometimes is very small.” When the alternative is death, it seems obvious that a physician would try alternate or “brave” interventions as a last resort; however, sometimes this will only harm the patient more. I used to work as a medical scribe in an Emergency Department, and I vividly remember one family member screaming at my attending physician when he decided to stop resuscitating their 98-year-old mother after 30 minutes. It was evident early on that this patient was not going to make it - she was so frail that I could hear her ribs cracking as our charge nurse performed compressions on her. But my provider granted the family's wishes and genuinely tried to resuscitate this woman until he felt that it was only harmful to continue. Even so, the patient’s family was understandably upset that my attending had made what he thought was the ethical decision to stop interventions on their mother. I completely understood the family’s response to the situation because when you do not have the experience caring for these patients, it is incredibly confusing to understand what made them decide to stop. I remember seeing my first cardiac arrest in the Emergency Room, and unfortunately, after over an hour of attempting to resuscitate the patient he passed away. At the time, I didn’t understand why they had decided to stop, even though they had already tried numerous different interventions with no improvement. Over time, I realized that the providers have learned through years of experience when it is appropriate to continue attempting to save a life versus when there is nothing more to be done or when the remaining interventions will only cause more harm. While most people think that a physician’s sole duty is to save lives, they also have duties to implement principles of non-maleficence and beneficence. Non-maleficence means to do no harm, while beneficence means to prevent/remove harm and promote good. I believe this was the intention of my attending physician when he decided to stop resuscitating our 98-year-old patient. Although this intervention could have potentially saved her life if we continued, we had already done great harm to the patient in the process, and deciding to remove the ineffective harmful interventions felt like the most ethical thing to do. Overall, this is undoubtedly one of the most challenging aspects of medicine. There is indeed a very fine line between stupidity and bravery, but it is up to the physician to use their experience and gut feeling to decide what the best decision for their patient is at that moment.
While Dr. Waldenberger used a primary example of taking a brave step forward to save a young patient at the risk of ending what life was left in the patient, I think about the ethical decisions that many physicians may have to make daily, especially in the surgery or emergency room context. I’m reminded of the ethical dilemma/question of what a person would choose to do in the train switch/track situation with saving one person versus five people and in many other situations, and how that decision may reflect a person’s ethical beliefs such as utilitarianism and many other viewpoints. Most doctors are probably not facing saving one person versus a group of people, but to provide a valid example, some obstetric physicians may have to make a tough decision in saving the mother versus saving the baby. I certainly concur that doctors have a huge amount of responsibility on their shoulders and their quick decisions can mean life or death to their patients, such as in the operating room, emergency room or delivery room. While I understand Dr. Waldenberger’s perspective on how the line between bravery and stupidity can be extremely thin for physicians, I also respect Dr. Waldenberger’s process on how a physician (or anyone in his/her own respective occupation) can learn from his/her experiences, including the healing process in the event a poor decision was made. His healing process of taking time to reflect and slowly, but steadily regain confidence is an encouraging reminder that while doctors do face ethical dilemmas, there’s opportunities to heal and grow from the process.
a moral, ethical physician.
If I ever need heart surgery, I hope he does it! Not many people are willing to redo the operation or take those risks
But then, eat correctly, so that one doesn't even need to consider surgery: No animal products, high nutrient organic plant foods, no oils (huge mistake, and still recommended), no sugar , no processed foods...these are thee link to heart problems...eat well, but all good plant foods, but also not too much...we kill ourselves with poor diet, and not good exercise............these things keep you from even having to see this guy at all...you'd never even run into him (unless at the gym!)
people like that don't get very far in this career. It's a hard place to reach and requires a lot of dedication. If your motives are not correct (e.g. your best interest is not to do whatever to help the patients) then it will be very hard for that individual to stay focused. I'm sure many (certified) surgeons would do what they can that is low risk but also increases chances of survival.
Heart disease is a product of genetics as well as of one's diet. The most anyone can do to remain healthy is eat well, exercise, have the right genetics and some good luck.
This guy is an amazing person... Kudos to you, kind, brave, sir.
What a great surgeon, amazing lecture. Very inspiring.
It's instructive and enlightening that Dr. W. learns so many profound lessons from his experiences in nature.
You are a good doctor, a good thinker and a good man. I think you spoke well to the points made and I agree with those ideas and choices! Thank you for your Service!
Mr Waldenberg great show at the tedx hope to go to one of these shows nice to see you great work Doctor.
Great lecture !
Thank you, Dr. Ferdinand. =)
This was a moving talk, and one of the lines that stuck with me the most was your point that “the line between bravery and stupidity is a delicate one.” While bravery is typically admired and rewarded, stupidity can have serious consequences, including injury or even death. This line is particularly relevant in your field of cardiac surgery, where the surgeon must balance risks and benefits of their actions to provide the best possible care for their patients. One consideration when discussing the line between bravery and stupidity is the concept of informed consent. Before any medical procedure, patients must be fully informed of the risks and benefits of the procedure, as well as any alternative treatment options. This allows the patient to make an informed decision about their own care, and to weigh the potential risks and benefits for themselves. A cardiac surgeon who operates without informed consent, or who performs a risky procedure without considering potential consequences, may be considered to be acting in negligence. Even with informed consent, however there could still be a fine line between bravery and stupidity. A surgeon who takes unnecessary risks or performs a procedure that is beyond their level of expertise could be considered to be acting recklessly. On the other hand, a surgeon who refuses to take risks or who shies away from difficult cases could be causing patients to miss out on potential life-saving interventions. A key ethical consideration in cardiac surgery is the principle of non-maleficence, which requires that the surgeon consider the potential risks and benefits and weigh them carefully before taking any action. A cardiac surgeon who takes unnecessary risks or who performs a procedure that is beyond their level of expertise could be seen as violating the principle of non-maleficence, as they are putting their patient at unnecessary risk. At the same time, the principle of beneficence, under an obligation to do good, requires that a physician take the action that most benefits their patients whenever possible. This can, certainly in the field of cardiac surgery, involve taking risks from difficult procedures, because a cardiac surgeon who refuses to take risks and shies away from difficult cases could be seen as technically violating the principle of beneficence. Hence: very thin line, as previously stated. Ultimately, that line between bravery and stupidity is a difficult one to navigate, and requires careful consideration of a range of ethical principles and considerations. By keeping the principles of informed consent, non-maleficence, and beneficence at the forefront of their decision-making process, cardiac surgeons can ensure that they are providing the best possible care for their patients while also balancing the risks and benefits of their actions. By walking this line with care and consideration, cardiac surgeons can be both brave and wise in their practice, providing the best possible outcomes for their patients.
I strongly agree. Especially when within the medical field and have the potential to greatly benefit or harm and individual's health, one has to greatly weigh the pros and cons of each action. Of course as a physician one must be willing to follow the boundaries of their expertise, but not push them as it could lead to irreparable damage. However, this raises the question of how can one properly ensure in an emergency or acute situation, it is that much more difficult to have the time to make proper risk assessments.
one of the best speeches TED has ever had!!!! Respect
A most amazing speech.
“Educated Courage Decisions” is the way!
what a great guy ..
good videos dont get much views
*Great one.*
Medical professionals must be willing to take calculated risks in order to save lives and improve the health of their patients. On the other hand, they must also be careful not to take risks that are too great, as this can put their patients in danger. Dr. Waldenberger’s stories were very insightful and helped me think about decision-making in medicine in a way that I hadn’t considered before. I can’t imagine how difficult it is to inform a patient enough to help them make the right decision for themselves when you have to weigh the risks and rewards carefully yourself. The trust that is required in risky surgeries causes a unique ethical dilemma hinging on the surgeon’s confidence in their own skills. What impressed me from Dr. Waldenberger, however, was how confidence in decision-making comes with experience, but it still requires trust.
Another example of the line between bravery and stupidity in medical care is the use of experimental treatments. While experimental treatments may hold promise for patients who have exhausted all other options, they can also be dangerous and have unpredictable outcomes. Medical professionals must weigh the potential benefits of these treatments against the potential risks, and make sure that their patients understand the risks and have given informed consent.
Another example is the use of aggressive interventions in end-of-life care. While some patients may benefit from aggressive interventions, such as life support or ventilators, others may not. Medical professionals must carefully consider the patient's wishes, quality of life, and likelihood of recovery before recommending or performing these interventions.
If I could ask Dr. Waldenberger a question about his experiences, I’d like to hear him talk about how having a competent team can help in the decision-making process. I can imagine that having diverse perspectives, collaborative problem-solving, shared responsibility, support, and feedback can be invaluable in difficult situations. Not only is it helpful when trying to decide what action to take, I feel like it would help alleviate the feeling of guilt and personal responsibility when you make a difficult surgical decision and things go wrong.
Great stuff
Many many times people are afraid to make decisions that have a greater chance of failure the ones that chose to go with the odds are what we call pioneers and is why we have advanced so much in the last 100 or so years.
Awesome! Such a shame that Heart Surgeons are not trained in PCI and EP procedures.
Love him, good man.
A true model in medicine!
The ethical dilemma of balancing beneficence and autonomy often arises when dealing with incidental findings during surgery. Several documented examples demonstrate the challenges of navigating this tension between these principles. In a study published in the Journal of the American College of Surgeons, researchers surveyed patients about their preferences for managing incidental findings discovered during laparoscopic cholecystectomy. They found that the majority of patients preferred shared decision-making with their surgeon, with many preferring to be informed of all incidental findings, regardless of the potential harm. This study underscores the importance of respecting patient autonomy in managing incidental findings, even if it may result in the patient declining further interventions. However, it is important to note that patient autonomy does not always trump the principle of beneficence. In a case of incidental findings that are potentially deadly to the patient and need to be addressed immediately, the surgeon has the obligation to do no harm and must proceed with the surgeon and potentially violating patients right to autonomy. The ethics of incidental findings during surgery is complex and requires a case-by-case approach. Of course, clear communication and shared decision-making can help to ensure that patients receive appropriate care they would prefer. However, this luxury if not always available and surgeons must make tough decisions that can rarely be career ending.
Im my experience working in a hospital, I would say 25% would consider the Hippocratic oath they took and do no harm meaning they would move heaven and earth tisane the patient. Even if the risk assessment isn't good. They call it risk because its a chance. It could come out good or bad, but there is still a chance. This Dr. I awesome and I can tell very passionate about saving lives. He is not a lazy Dr. in it for the money and ego like many American Doctors. Bless this man! Good Job Dr.!
I wish this guy was my doctor
Sad a man this amazing has no fame. Instead this world gives complete idiots that drop out of high school famous.
🙏🏼❤️🎓
He sounds like Arnold S. Amazing man
The comment that i was looking for 😂have a Nice one buddy
Dr. Waldenberger makes a strong case for the ethical principle of beneficence, and he explains how he balances this with the principle of non-maleficence. He argued that in most cases he views his ethical duty to provide the best chances of survival for the patient in cases where the patient is dying and a risky procedure may save their life. This is such a hard topic for me, because your view of doing what is best for a patient may not be what the patient wants. In emergency cardiac surgery there is no time to ask the patient what he or she wants, thus I think its reasonable to use the guiding principle of beneficence to try to give the patient the best chance of survival, given that your intervention won’t leave them disabled with a very poor quality of life. In specialties where there is more time to talk to your patient ahead of time and be able to understand what they value; I believe that would be more in line with the principle of beneficence. Dr. Waldenberger tells two stories of him saving patients lives even when it would have been reasonable to stop medical intervention, but then he also tells the story of his mom dying because of lack of medical intervention. He talks about both of these situations being good, so I think the decision to intervene or not is a very complex one and requires a multifactorial assessment. Balancing the principles of non-maleficence and beneficence needs to have an assessment of quality of life for the patient after the given medical intervention, say that the patient will die without X medical intervention, but doing said intervention could leave them severally debilitated and wouldn’t allow them to live for much longer. I would argue in a circumstance such as that, you would be causing harm to the patient by prolonging their life. But in a circumstance where trying X medical intervention would prolong the patient’s life with a lower risk of disability, I think it would be a decision in line with the principle of beneficence.
Waldenberger highlights the ethical challenges that heart surgeons face in making difficult decisions about whether to operate on patients with life-threatening conditions. Waldenberger emphasizes that while doctors have a responsibility to prioritize their patients' well-being, they also have a duty to do no harm. He describes the case of a patient who is at high risk of death without surgery, but whose chances of survival are uncertain even with the operation. Waldenberger explains that in these situations, doctors must carefully weigh the potential benefits and risks of the procedure, taking into account not only the patient's medical condition but also their individual values and preferences. Waldenberger argues that ethical decision-making in medicine requires a holistic approach that considers not only the physical health of the patient, but also their psychological, social, and spiritual well-being. He emphasizes the importance of communication and collaboration between doctors, patients, and their families to ensure that medical decisions are made in a way that reflects the patient's values and priorities. Reflecting on Waldenberger's points, it is clear that the ethical challenges facing heart surgeons are complex and require a thoughtful and nuanced approach. While doctors have a responsibility to prioritize the well-being of their patients, they must also consider the potential risks and benefits of medical interventions, as well as the patient's individual values and preferences. By prioritizing open communication and collaboration, doctors can work with their patients to make decisions that are truly in their best interests. Dr. Waldenberger's talk highlights the ethical challenges that heart surgeons face when deciding whether to operate on patients with complex medical histories and poor prognoses. One potential argument that builds off his points is the need for a more transparent and patient-centered approach to decision-making in medical settings. Currently, many medical decisions are made by a small group of experts, often without full transparency or input from patients and their families. This can lead to situations where patients may not fully understand the risks and benefits of a given treatment, or may not have the opportunity to voice their own preferences and values. By adopting a more patient-centered approach, which involves open and honest communication with patients and their families, as well as shared decision-making that takes into account the patient's individual needs and goals, we can help to ensure that medical decisions are more in line with patients' wishes and values. Furthermore, incorporating patient perspectives and experiences into the decision-making process can also help to identify areas where medical practice can be improved, and can lead to more patient-centered and effective care. Ultimately, by fostering greater collaboration and transparency between medical professionals, patients, and their families, we can help to ensure that ethical dilemmas like the ones Dr. Waldenberger highlights are navigated in a way that prioritizes the patient's wellbeing and values.
December 3 1967 was the first heart transplant, not 1969.
What a decent human. The highest compliment!!!!
I'm so glad his mum died NOT from suffocation: I experienced awake paralysis with suffocation (paralysed by 'muscle relaxants' & serious errors with breathing tube) in the operating theatre in the UK in 2005 = HORROR: I couldn't breathe nor save myself and 'died' and had an out of body experience up near the ceiling looking down.
I've read that quite a high percentage of heart op patients have near death experiences (NDEs) and out of body experiences, I wonder if this doc asks patients after ops or better still (whenever possible) warns them it might happen? It would be great if he (and other surgeons/docs/nurses) could give a talk about this because they mostly refuse to admit that it happens and if it does = never to THEIR patients!
My docs refused to tell me what the did wrong and lied to me, my GP and other docs, I never got justice and am left seriously injured, including brain, neck & throat injury. Docs must be taught that they WILL make serious mistakes (to err is human) and that treating the patient with respect, believing us and helping us after is obviously the right thing to do - the lies made me go out to commit suicide one day, but I was too chicken to do it; the emotional consequences far more difficult to deal with than even my VERY serious injuries.
I have said I NEVER want to be intubated again, if I'm going to die I want help to die FAST and not suffocate, nor die from hunger & dehydration as I've read happens when docs decide to withdraw feeding and hydration = that is SO cruel.
ONLY 2 COMMENTS?
My question is, does the heart recepient comes back as a new bieng ,with a totally different emotions ,since we all know that emotions comes from our deepest depths an that would be our hearts, so does the recipient gets to take over the donors emotions an not his own?
The heart is a muscle, emotions come from the limbic system in the brain.
my two favorite medical youtubers in a one video 🙏🏻❤
@@eileene.5870 my emotion comes from my balls
Protocols and proven methods are there for a reason. They’re tried and true and we should be very cautious before disregarding them. But as Dr. Klagenfurt suggests, sometimes the situation requires you to do something different. If no physician ever had the courage to try something new or go against established “best practices,” we’d never had any medical advances. When it becomes obvious that established methods won’t work, I think a physician has a moral imperative to try whatever they feel will be best for the patient. Of course such variations from established norms must be taken only in rare instances when a unique situation requires it. You must be able to justify what you’ve done using solid reasoning supported by evidence. And it must be done for the right reasons. Those reasons shouldn’t be for your own pride or because you’re seeking prestige. Rather, you should only break from protocols and proven medical science when you’re confident it will be what’s best for the patient. You should have a good enough relationship with your patient to have a pretty good idea of what they would want. Being willing to stand up and do what you believe is right for your patient regardless of the consequences is true courage, and what’s needed in the profession.
The stage background belongs on r/mildlyinfuriating
Reddit is cringe
A poignant presentation from an experienced heart surgeon.
The most important thing is not to be a
No comments
the story is excited but sternum impossible to cut by sissores , sham to the cardiac surgeon to say that
Lol, shame on you for such disrespect! First learn to respect human!
It is possible, believe me. Strong sciccors though. No shame necessary.
Ferdinand Rudolf Waldenberger
Mic drop! Great work Doctor!
Ahmed Alsaeedi Noe Schitt-Sherlock. I won’t be doing that since it’s impossible. Ok sarcasm aside. It is possible. With good scissors and a strong hand.
I believe Dr. Waldenberger perfectly explained the moral dilemma physicians often experience when it comes to their patients. Dr. Waldenberger states that “we need to go for the minimal harm, for the maximal benefit for the patient.” This concept touches on the two ethical principles in healthcare: non-maleficence and beneficence. Non-maleficence is the physician’s obligation to do no harm, while beneficence is the physician’s obligation to act only in the benefit of their patient. There is a fine line between the two that physicians often must tight-rope across in emergent situations. In the example of Dr. Waldenberger’s elderly patient, whose initial surgery failed once taken off bypass, there was only minutes where he had to make the decision balancing minimal harm and maximal benefit. There was an extensive risk to be taken if he proceeded with correcting the surgery; however, with what Dr. Waldenberger describes as “educated courage,” he was able to carefully fix the errors and save his patient’s life. I believe that this type of decision does not have one correct answer; each situation is different and depends highly on prior experience. What I found most troubling, was the fact that Dr. Waldenberger almost was fired after performing an emergent aneurysm repair on a patient, all because he failed to inform his boss and the hospital. We already expect so much from surgeons, placing another individual’s life in their hands; we cannot punish them for doing their job. There needs to be a reform within the system to allow these surgeons to do what they do best without the fear of repercussions from their superiors. In cases like these, surgeons are less likely to show “educated courage” when operating on their patients, ultimately leading to poor outcomes all because of fear of the system. If physicians and surgeons all adopt the same way of critical, yet ethical, thinking like Dr. Waldenberger, the advances within the medical field will continue to grow and prosper for the good of the patient.
In the medical field, ethical dilemmas can arise in various situations, particularly in high-stress environments such as surgery. This talk highlights the ethical dilemmas faced by heart surgeons, particularly in the context of organ donation.
One of the key ethical principles in medicine is beneficence, which emphasizes the importance of promoting the well-being of patients. However, in some cases, such as with organ donation, the ethical principles of non-maleficence and justice can come into conflict with beneficence. In this talk, Waldenberger addresses the ethical challenges of balancing the needs of the patient with the wider societal interests of organ donation.
Waldenberger argues that the ethical dilemmas faced by heart surgeons require a multidisciplinary approach that takes into account the perspectives of various stakeholders, including patients, families, and medical professionals. He emphasizes the importance of transparency and open communication in addressing these challenges.
Another important ethical principle in medicine is autonomy, which recognizes the right of patients to make informed decisions about their own healthcare. Waldenberger highlights the importance of respecting patient autonomy in the context of organ donation, particularly when patients may be in a vulnerable state and may feel pressure to donate.
Overall, this highlights the importance of approaching ethical dilemmas in medicine with a comprehensive and multidisciplinary perspective. By prioritizing principles such as beneficence, non-maleficence, justice, and autonomy, we can work towards a more ethical and just healthcare system.