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In Reply: Nerve Surgeons’ Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice

2018; Lippincott Williams & Wilkins; Volume: 83; Issue: 4 Linguagem: Inglês

10.1093/neuros/nyy329

1524-4040

Andrew Yee, Demetrius M. Coombs, Sabine Hildebrandt, William E. Seidelman, J. Henk Coert, Susan E. Mackinnon,

Ethics in medical practice

To the Editor: We thank the authors of the letter that was written about our article.1 We agree that the Jewish principle of Pikuach Nefesh should not be overgeneralized.2 It requires a thorough, case-specific examination according to Jewish ethics laws before the use of Pernkopf's atlas in surgery can be permitted. We recommend surgeons study the Vienna Protocol by Rabbi Polak, as it provides comprehensive guidelines “for when Jewish or possibly Jewish remains are discovered.”3 While the Vienna Protocol describes how these materials are to be ethically handled, there is a need for the deeper examination of the rationale and intentions of surgeons for using the atlas to navigate a procedure in the operating room.4 There exist several alternatives to the atlas when a surgeon encounters difficulty during a case. These include, but are not limited to, taking an intraoperative timeout to reorientate oneself, consulting a surgical colleague for assistance, and/or consulting an anatomical resource other than Pernkopf's atlas. We recommend a stepped approach in an upcoming ethics study, in which the Pernkopf atlas can be used “only as last resort” if a surgeon uses the atlas under the condition “to benefit a patient's life.” The purpose of our article is to determine whether a 4-point proposal addressing significant domains could progress the Pernkopf controversy. As described, this includes (1) a historical disclosure,5 (2) facilitating discussions in bioethics on the appropriate use, (3) perspectives and advisory from the Jewish authorities,3 and (4) an official memorial dedicated to the victims illustrated in the original paintings of the atlas.6 Pernkopf's controversy is further significant because of its circulation as a printed atlas in the used book markets and unofficial digital scans passed among surgical peers. More importantly, nerve surgeons have found a use of the atlas for navigating complex anatomy, which has not been accurately described elsewhere. We collectively aspire for a future, when Pernkopf's atlas becomes a memorial to the victims, and its content is replaced by a new surgically relevant anatomical resource. Until then, we as moral individuals are considering a multidisciplinary approach for progressing this controversy. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.