# The whole person beneath the drapes: a philosophical reflection on human-centeredness in the operating room

## TL;DR

This paper explores how patients in surgery can become overlooked as people, and suggests ways to maintain ethical care through philosophical insights.

## Contribution

The paper introduces a novel ethical framework for surgery by integrating Descartes and Rogers to address depersonalization in the operating room.

## Key findings

- Clinical detachment in the OR can erode recognition of patients as persons of moral worth.
- Anesthetized patients remain morally present, requiring heightened ethical duty of care.
- Rogers' humanistic principles can guide surgical teams to uphold patient dignity alongside technical precision.

## Abstract

In the highly technical and time-pressured environment of the operating room (OR), patients may risk becoming physically present yet experientially absent and ontologically overlooked. “Experiential absence” refers to the loss of the patient’s subjectivity when their voice and awareness are silenced under anesthesia, while “ontological absence” refers to the erosion of their recognition as a person of inherent moral worth. Drapes, protocols, and clinical shorthand can unintentionally reinforce this absence. While such detachment supports surgical focus, it raises pressing ethical questions.

This paper undertakes a philosophical reflection drawing on René Descartes’ Meditations and Carl Rogers’ humanistic psychology. Primary texts from both authors are engaged to examine how Cartesian dualism has shaped depersonalizing tendencies in biomedicine, and how Rogers’ principles of empathy, authenticity, and unconditional positive regard can reframe ethical care in surgery.

Three interrelated dimensions are identified. First, the paper distinguishes between necessary clinical objectivity and harmful detachment, arguing that the latter undermines ethical regard. Second, it reconceptualizes the anesthetized patient as morally present despite unconsciousness, emphasizing that vulnerability under anesthesia heightens the ethical duty of care. Third, it reframes the surgical team as a therapeutic environment, where interpersonal respect and psychological safety influence how patient dignity is upheld.

Integrating Rogers’ philosophy into the OR does not compromise technical precision but deepens it with moral clarity. By recognizing both the experiential silence and the ontological presence of the anesthetized patient, surgical teams can align technical excellence with ethical responsibility. This perspective expands patient-centered care into a more robust person-centered ethic, positioning surgery not only as a technical intervention but also as a profoundly moral encounter.