ArticleJournal of evaluation in clinical practice2026
When 'No Surgery' Is Chosen: A Five-Domain Framework for Evaluating Ethical Consent in Non-Operative Hip Fracture Care.
Article in Journal of evaluation in clinical practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundHip fracture in frail older adults is commonly managed surgically, but non-operative management may be appropriate for selected patients with extreme frailty, limited life expectancy, severe cognitive impairment, multimorbidity or limited expected benefit from surgery. However, when 'no surgery' is chosen, documentation of consent or refusal may complete a procedural requirement without ensuring ethically sufficient decision-making.
methodsA structured, literature-informed conceptual ethical analysis was conducted using PubMed and Scopus searches, citation tracking and synthesis guided by the four principles of biomedical ethics.
resultsFour ethical gaps are identified: non-operative burdens are often naturalised, 'conservative treatment' may be mistaken for comfort care, family signatures may not fully represent patient values, and refusal of surgery does not end clinical responsibility. These recurring concerns are organised into a five-domain framework: Burden, Goal, Voice, Balance and Commitment.
conclusionsNon-operative hip fracture care should move from procedural consent to ethical consent. The proposed framework may support balanced risk communication, goal clarification, patient-centred decision making and continued care planning when 'no surgery' is chosen.
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