Surgery is often described through the language of art, science, and skill, but when these eclipse the human meaning of illness and suffering, surgical care can dehumanize. A technically brilliant operation can still leave behind a morally diminished encounter. If surgery saves tissue but neglects personhood, the profession should be uneasy with calling that excellence. Empathy is the moral capacity that allows surgeons to recognize patients and families as persons rather than cases and problems, which is why many new graduates now begin practice with a public declaration of professional duties 1. Rapid technological change, algorithmic decision tools, remote interactions, and workforce strain can unintentionally push surgery toward depersonalization and leave less emotional bandwidth for humane practice. In this setting, empathy should be treated as an explicit professional duty rather than an inherited tradition. Clinically, empathy is emotional resonance paired with checking back to confirm or correct shared understanding, so patients feel heard and understood 2. It is enacted through attention, presence, and restraint under pressure. However, hierarchies and the hidden curriculum in surgical training can erode empathy from clinical entry through residency 3. The declaration on professional empathy for surgeons by the International College of Surgeons is therefore timely; it makes empathy a shared professional obligation that anchors technical excellence to humanism 4. Without such an anchor, surgery risks becoming efficient, data-rich, and procedurally sophisticated, yet morally thinner at the bedside. Declarations have a particular ethical function. They do not replace institutional policy or define legal obligations. They can, however, make values visible, unify language across cultures, and offer a shared direction for education, leadership, and professional identity. That function matters because professions do not retain public trust by competence alone; they retain it by showing that privilege remains answerable to humanity. The declaration is organized across five domains: personal and professional commitment, leadership and team culture, reflection and moral growth, systemic and societal context, and clinical relationships including responses to adverse outcomes. The declaration's design carries two ethical insights. First, empathy is described as a disciplined practice, not a constant affective state. This matters because surgical work is shaped by fatigue, uncertainty, moral distress, and systemic constraint. A constructivist grounded-theory study of Australian general surgeons describes deliberate strategies to respond to patient emotions, chosen to balance urgency, time available, and the surgeon's own psychological resources 5. Second, the declaration avoids demanding perfection. It explicitly recognizes that empathy can falter and frames ethical growth as arising from reflection, accountability, and the courage to return to humane practice after difficulty. Patient and family experiences are recognized as essential perspectives for improvement. When those experiences are ignored, the problem is not merely poor communication; it may reflect a deeper ethical failure in how surgery understands suffering and responsibility. Across its domains, the declaration frames empathy as disciplined practice grounded in dignity and vulnerability, expressed through presence, attentive listening, and detachment without indifference. It links empathy to leadership and team culture through humility and psychological safety, and trainees' accounts of competition discouraging help-seeking reinforce the need for structures that make help seeking safe 6. It also treats training as moral formation shaped by tone and the hidden curriculum, argues that technology should support rather than displace human connection, and extends empathy to families and to responses after harm through disclosure, appropriate apology within local processes, and learning 7. A training culture that treats emotional suppression as maturity may produce composure, but it can also normalize detachment, silence vulnerability, and miseducate surgeons about what professionalism truly demands. Empathy can be misunderstood as performance, forced positivity, or a tool for blame. The declaration's framing helps prevent this. First, it describes empathy as disciplined practice within human limits. Second, it refuses perfectionism. Third, it explicitly separates values from legal standards of care. These safeguards matter, especially in resource-constrained contexts where moral distress can be acute. The greater danger, however, may be the opposite error; not that empathy asks too much of surgeons, but that the profession has too often expected too little from itself beyond technical success. Values become credible when they show up in daily work. If empathy is praised in ceremonial language but absent in ordinary behavior, the profession risks performing virtue rather than practising it. Empathy should be taught similar to any other clinical skill. Educational efforts to teach surgeon communication and empathy have often been local and subspecialty specific. Scaling depends on institutional and national commitment and resourcing, and this is where a declaration can align expectations and make implementation coherent 3. Use brief coaching in ward rounds, clinics, and morbidity and mortality meetings. Practise listening, naming emotion, checking understanding, and inviting questions. Assess trainees for respect and clarity, not only factual accuracy. Culture matters as much as skill. Make the hidden curriculum visible. Name behaviors that are unacceptable, such as humiliation and belittlement. Link them to patient safety and professionalism. Reward teaching that is firm but respectful. Create psychologically safe spaces where juniors can speak up without fear. Add short reflection and ethics debriefs after difficult cases. Include emotional impact, communication dilemmas, and value conflicts. Treat moral language as professionalism, not fragility. Systems must support these expectations. Clinician wellbeing is an ethics issue and a safety issue. Protect rest where possible and provide confidential support. Offer peer support after complications. Hold leaders accountable for team climate. Keep care human when technology is used. Explain uncertainty and clarify who is responsible for decisions. Make room for patient questions that connect recommendations to values. After harm, support honest disclosure and consistent communication with families. Use a just culture approach so learning is real and blame is proportionate. Empathy after harm must be both personal and institutional. In conclusion, the Singapore Declaration on Professional Empathy for Surgeons reasserts a professional truth: surgical excellence is incomplete without humane care. By articulating empathy across personal conduct, team culture, training environments, societal context, and responses to harm, it offers a shared language that can travel across diverse healthcare systems. Its success will be measured not by endorsement alone but by whether it reshapes the hidden curriculum, strengthens psychological safety, supports clinicians as moral agents, and sustains transparency and learning when outcomes are adverse. In a rapidly changing world, empathy remains not a soft ideal but a disciplined practice that keeps surgery human. Vishal G. Shelat: conceptualization, writing – original draft, writing – review and editing. The author has nothing to report. The author has nothing to report. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Vishal G. Shelat (Sun,) studied this question.