Ethical aspects of waiting lists in neurosurgery

PURPOSE: Long waiting times for elective surgery have been a persistent problem in many countries since well before the COVID-19 pandemic. This study aims to describe the extent of waiting lists&times for elective neurosurgery and discuss the potential ethical dilemmas they pose.

METHODS: A narrative review was conducted on waiting lists & times in neurosurgery using PubMed and the Web of Science Core Collection.

RESULTS: The majority of the available data on elective surgery waiting times and lists are based on analyses of non-neurosurgical interventions. These are generally high-volume surgical procedures, such as cataract surgery, hip replacement, and knee replacement. Elective surgery waiting times challenge the clinical application of the bioethical principles of beneficence, nonmaleficence, autonomy, and justice. Extensive waiting may prolong time to benefit or even lead to harm. Moreover, failure to receive timely care runs counter to patients' autonomous wishes to be treated without delay. Finally, different principles of distributive justice are likely to contradict each other under the conditions of restrained access to care that exist when patients must wait for care. It is essential to ensure that patients on waiting lists receive fair access to health care services.

CONCLUSION: This analysis indicates that long waiting lists potentially violate three of the four basic biomedical principles proposed by Beauchamp and Childress. The fourth principle, justice, is also challenged and remains to be analyzed in reference to underlying ethical principles. From an ethical perspective, waiting lists create accountability at the governmental, institutional, and physician levels, although not to an equal degree.