Surgical Ethics, Legal Aspects and Health Administration
This domain tests consent, confidentiality, disclosure of harm, documentation, and the organisation of the Cuban health system in which surgical practice takes place. Questions are scenario-based: a competent patient refuses, a relative demands information, a complication must be recorded.
Consent and capacity
- Informed consent requires capacity, adequate information (diagnosis, nature of the operation, material risks, alternatives, consequences of refusal) and voluntariness; document the discussion in the record.
- Capacity is decision-specific: the patient must understand, retain, weigh and communicate the decision. A competent refusal of life-saving surgery must be respected.
- Minors: consent comes from parents or guardians with the child's assent according to age and maturity; in emergencies, treatment may proceed without consent under necessity.
- Jehovah's Witness patients: respect refusal of blood products, plan bloodless surgery, and record the advance directive.
Duties and records
- Confidentiality has defined exceptions: legal obligation, serious risk to third parties, and the patient's consent.
- Disclose adverse events honestly to the patient and report them through the institutional quality system rather than concealing them.
- The clinical record is a legal document: consent, operative note, postoperative orders and discharge summary must be complete, timed and signed. Corrections are made by dated addendum, never by rewriting.
- Negligence requires duty, breach, causation and damage; most claims follow poor communication and documentation rather than technical error.
The Cuban health system
- The Sistema Nacional de Salud is free, universal and state-funded, organised from the family doctor's consultorio through the policlínico to the provincial and national hospitals.
- The Programa del Médico y la Enfermera de la Familia places a doctor-nurse pair in the community; referral for surgical assessment usually begins at this level.
- Surgical services are regionalised by complexity; teaching hospitals combine care, teaching and research.
- Research requires ethics committee approval and informed consent, consistent with the Declaration of Helsinki.
Worked example
A competent adult with a gangrenous foot refuses amputation. Reasoning: confirm capacity and that the refusal is informed, discuss alternatives and consequences, involve family only with his permission, and document the conversation. Treat conservatively and continue offering surgery; do not operate without consent unless a specific legal provision or court order applies.
Traps
- Obtaining consent for a competent adult from a relative.
- Treating consent as a signature rather than a conversation.
- Amending a record after an adverse event without a dated addendum.
- Confusing clinical audit with research, which needs ethical approval and consent.