Sometimes, deciding when not to have surgery is just as important as deciding when to have surgery. No one understands this better than Casey Humbyrd, chief of the Foot and Ankle Division, and assistant professor of orthopaedic surgery and associate faculty member at the Johns Hopkins Berman Institute of Bioethics. Humbyrd researches surgery, ethics and decision-making, and she brings this expertise to her patients like Stuart and Suzanne Drake. For the Drakes, Humbyrd’s guidance was instrumental in their own decision-making, and it inspired them to support the surgeon’s bioethics research.
“It’s very important to support old-fashioned medical ethics, which begins with understanding the patient,” says Stuart. “Dressed up as it may be in the new discipline of bioethics, Dr. Humbyrd epitomizes it by the way she handles people who are in pain and who have uncertainty about the best course of treatment.” He says Humbyrd’s approach recalls the medical ethics of his uncle, who, in the 1940s, was one of the first board-certified pediatricians in Southwestern Virginia. “She is the closest that I have found to a physician with the same type of empathy that I saw in my uncle.”
When Stuart’s wife started having tremendous pain in her foot, they made an appointment with Humbyrd. During the visit, they discussed the surgical options. “Dr. Humbyrd put my wife’s dilemma about whether to have surgery, which would have involved three to six months off her feet, in the context of our personal situation,” says Stuart. “She understood and related to us. When somebody is in pain, that attitude is enormously reassuring.”
The Drakes and Humbyrd discussed the bioethics involved in operating on a foot that may not need it. Humbyrd says surgeons have an ethical responsibility to adhere to the principle of nonmaleficence or “do no harm,” which is a key tenet of bioethics. A decision about surgery is often complex, but a surgeon who is well trained in bioethics can present the nuances of the options to help a patient make the best choice. “That was a fascinating discussion,” says Stuart. “We became very fond of Dr. Humbyrd through that conversation.”
Humbyrd’s research currently includes the ethics of new payment models for total joint replacement and their potential effects on access to care for vulnerable patient populations. Future research will consider ethical issues related to limb-threatening injuries — issues such as whether to reconstruct or amputate an injured limb, understanding the attitudes of orthopaedic surgeons about ethical issues and examining the ethics of opioid prescribing.
This year, Humbyrd is running a nationwide symposium on ethical considerations when prescribing opioids after orthopaedic surgery. “Through my work as a delegate to the American Medical Association and my recent appointment to the board of the American Orthopaedic Foot & Ankle Society,” she says, “I have a national platform to help promote ethical care in orthopaedic surgery, especially with regard to opioid prescribing.” Donations like those from the Drakes help make research possible, and improve patient care and strengthen the health care system.