By Isabella Grace Carnovale

Suppose your loved one is having a routine surgical procedure, and something goes wrong. The
surgeon could try an innovative technique to save them, but does not know whether it will work,
or what the long-term side-effects of the innovation might be. Is it right for the surgeon to
innovate in this situation? And what moral obligations do they have if they do?

A lot of work has been done exploring the ethical implications of surgical innovation, but almost
none of this work focuses on unplanned innovations that aim to solve problems that arise during
surgery. Almost exclusively, bioethicists discuss how surgeons best navigate the period before a
planned surgical innovation (e.g., how informed consent should be carried out).

However, surgical innovation can happen without prior planning. A problem might occur during a
surgery that has no standard resolution. In these cases, surgeons might need to innovate to save
their patient. I call this “spontaneous surgical innovation”.

Spontaneous surgical innovations raise unique ethical challenges. Patients can’t give pre-operative
informed consent for spontaneous innovations like they can for planned innovations. And questions
of liability are complex: if a surgeon has to innovate to save their patient, but the patient is harmed
or even dies as a result of the innovation, it’s unclear if we should hold them accountable. We don’t
want surgeons to feel as though they can’t try everything to save a patient, but we also don’t want
surgeries where “anything goes”.

Judging the decision to innovate without prior planning is a difficult task, especially given how
context dependent these kinds of on-the-spot choices are. Assigning accountability requires us to
know more about what kinds of intraoperative events make spontaneous innovations permissible,
and whether surgeons are ever obligated to innovate in specific contexts.

Spontaneous innovations can generate valuable knowledge. Given their context (responses to
intraoperative events), spontaneous innovations give us insight into surgical approaches that we
might not get otherwise. We might then want to consider whether surgeons have a duty to share
their innovations with the broader surgical community.

Unlike spontaneous innovations, planned innovations are carried out in the context of research and
with broader sharing already in mind. It will be difficult to carry out research or trials on the kinds of
innovations we might see with SSI given that they occur in response to unpredictable intraoperative
events. As such, when spontaneous innovation does occur, any knowledge gained will be significant
and this creates an obligation of the surgeon to share this knowledge.

In this paper, I introduce spontaneous surgical innovations as a distinct kind of innovation that needs
to be explored independently of planned innovations. I discuss some real case examples and some
potential starting points for approaching some of the challenges mentioned here. Until now,
spontaneous surgical innovation has been looked over and its ethical implications left unexplored
and unaddressed. My hope with this paper is to show that spontaneous surgical innovation conjures
up a number of both ethical and epistemic challenges and that both patients and surgeons will
benefit from a better understanding of SSI.

Paper title: Spontaneous Surgical Innovation

Author: Isabella Carnovale

Affiliations: Macquarie University

Competing interests: N/A

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