Hackensack Meridian Health Doctor Bioethicist Publishes Surgery Decisionmaking Piece in New England Journal of Medicine

Charles Binkley, M.D., FACS, HEC-C, the director of Bioethics for the health network’s Central Region, and also an associate professor of Surgery at the Hackensack Meridian School of Medicine explores the difficulties of decision-making for surgeons in a new piece in The New England Journal of Medicine. 

Binkley, who co-authored the piece with Joel Michael Reynolds, Ph.D., of Georgetown University, and Andrew Shuman, M.D., of the University of Michigan, wrote that making clinical decisions based on how a patient appears to a surgeon may be subject to "ableist" biases. A doctor's subjective "eyeball test" might make assumptions about a patient's quality of life and influence whether or not a patient is offered a surgical procedure. 

“From the Eyeball Test to the Algorithm - Quality of Life, Disability Status, and Clinical Decision Making in Surgery” contends that more data and an empirical framework involving algorithms would aid doctors, who must seek out more input than just their sole observation of the patient in deciding whether a surgical intervention is “worth it.”

The paper poses several hypotheticals - including a case of a patient who would need extensive craniofacial surgery to remove a tumor, a procedure which would result in total blindness. Such a massive operation would be questioned, historically. But Binkley and his colleagues contend that automatically assuming that complete blindness would lead to a dramatically decreased quality of life is “ableist” - and should be reconsidered with data from other patients’ experience. 

The paper was published in The New England Journal of Medicine on Oct. 6.