Singapore Declaration on Professional Empathy for Surgeons
Preamble
We, the undersigned surgeons, educators, and healthcare leaders, united by a shared commitment to clinical excellence, ethical integrity, and global cooperation, affirm that empathy lies at the heart of surgical care.
This declaration carries forward the legacy of Dr. Max Thorek, whose founding of the International College of Surgeons in 1935 was inspired by a vision of cross-border collaboration, educational stewardship, and the highest ideals of professional conduct. Thorek believed that surgery must be more than technical mastery: it must be grounded in humanity, humility, and moral clarity. This declaration echoes that call and reaffirm empathy as a moral and clinical imperative in modern surgical practice.
We gather in Singapore, a global crossroads of culture, innovation, and medical excellence, to reaffirm these timeless values. As a city-state known for its commitment to healthcare quality, inclusivity, and forward-thinking leadership, Singapore is a fitting birthplace for a renewed declaration on empathy in surgery. Its strategic and symbolic position between East and West underscores our shared responsibility to make surgical practice both excellent and ethical, everywhere.
In a post-pandemic world shaped by rapid technological change, algorithmic decision-making, and increasing depersonalization of care, empathy remains an endangered virtue. While machines evolve, it is our moral imagination, our ability to understand, connect, and care, that sustains the soul of surgery. This declaration responds to a global need to rehumanize surgical care, anchoring technical progress in the enduring values of compassion, collegiality, and moral responsibility.
This Declaration is articulated through five thematic domains: (A) Personal and Professional Commitment, (B) Leadership, Team culture and Collegiality, (C) Reflection, Learning, and Moral Growth, (D) Changing world and Systemic & Societal Contexts, and (E) Clinical Relationships and Adverse Outcomes; expressed in fifteen declarations that affirm empathy as both a virtue and a professional imperative.
We affirm that empathy is a foundational value in surgical practice, essential across cultures, contexts, and clinical systems, while recognizing that its expression may vary according to local realities.
We acknowledge that empathy is not a constant state, but a disciplined practice shaped by fatigue, uncertainty, systemic constraints, and moral distress. Surgeons are human, not infallible. There will be moments when empathy falters, when pressure overwhelms intention, and when ideals are difficult to sustain. This Declaration does not demand perfection. Rather, it affirms a shared direction toward greater awareness, humility, and moral attentiveness by recognizing that ethical growth arises not from flawlessness, but from reflection, accountability, and the courage to try again. We recognise that patient and family experiences provide essential perspectives for reflection and improvement in empathic care.
This Declaration is a values statement and does not create legal obligations or define standards of care and it complements (does not replace) existing institutional policies. Nevertheless, it articulates professional ethical expectations that should inform conduct, education, and organisational culture.
Declaration
(A) Personal and Professional Commitment to Empathy
1: Empathy as a Core Moral Value
We recognize that every patient is a human being: unique, vulnerable, and worthy of dignity. Empathy is the moral imagination that allows us to grasp the fears, hopes, and suffering of our patients not as data points, but as lived realities. Empathy strengthens respect for patient autonomy by supporting honest information-sharing, shared decision-making, and free and informed consent. Empathy deepens clinical understanding, enhances trust, and supports communication and shared decision-making, which are widely associated with patient experience and care processes.
We resolve to uphold empathy as a foundational principle in our decisions, interactions, and institutional values.
2: Empathy as a Way of Being
Empathy is not an occasional task. It is a disposition cultivated daily. We reject the gradual numbing that occurs when clinical routines overshadow the personhood of our patients. Through reflective presence, attentive listening, and a commitment to understanding each patient’s story, we keep empathy alive in our work.
We resolve to cultivate empathy as a way of being, not merely an occasional expression.
3: Detachment Without Indifference
We strive to maintain emotional balance without losing our sensitivity. We regulate our emotional engagement to prevent burnout while preserving human connection, especially during high-stress situations. We acknowledge that detachment is not the absence of feeling, but the presence of discipline, an ethical effort to remain composed without becoming cold.
We resolve to stay present, compassionate, and morally attentive in each clinical encounter, within human limits.
(B) Leadership, Team Culture, and Collegial Empathy
4: Service Without Ego
We act in service of patients and teams, striving to place professional responsibility above personal recognition or ego. By embracing humility and rejecting ego-driven behavior, we create safer, more collaborative surgical teams.
We resolve to let humility anchor our daily surgical practice and team culture.
5: Empathic Leadership
We lead by example, showing empathy not only in words and actions, but in decisions and silences. We recognize that our behavior influences the culture of surgical teams and that psychological safety is co-created across disciplines, encouraging openness and fostering moral accountability.
We resolve to practice and promote empathic leadership, especially in moments of crisis and uncertainty.
6: Empathy Toward Colleagues and Self
We extend empathy to our peers and ourselves. We support one another through fatigue, professional grief, and ethical strain, and advocate for systems that protect well-being and mental health.
We resolve to foster a culture of support, reflection, and shared humanity.
(C) Empathy in Reflection, Learning, and Moral Growth
7: Empathy in Uncertainty and Moral Distress
Surgical care often unfolds in conditions of uncertainty, time pressure, and moral complexity. We recognize that empathy provides both grounding and guidance in such moments, helping us engage ethically even when decisions carry risk, ambiguity, or emotional burden.
We resolve to uphold empathy as a compass during moral distress and clinical uncertainty, preserving our humanity and integrity.
8: Commitment to Growth and Reflection
We actively pursue growth through mentorship, ethical inquiry, and emotional awareness. By progressively embedding narrative reflection, peer dialogue, and structured ethics debriefs into surgical education, we cultivate deeper moral sensitivity.
We resolve to grow empathy as a skill and a virtue.
9: Empathy in the Learning Environment
Surgical education is a crucible for character formation. We recognize that the way we teach through tone, feedback, and emotional modelling, directly shapes the moral development of future surgeons.
We resolve to build learning environments that reinforce kindness, curiosity, and moral awareness, not just technical mastery.
10: Empathy and the Hidden Curriculum
Beyond formal teaching, empathy is transmitted through the hidden curriculum; the unspoken cues, routines, and micro-behaviours embedded in daily surgical life. We acknowledge that hierarchy and power can distort empathy, and we commit to fostering environments where psychological safety allows empathy to be expressed without fear.
We resolve to examine and actively influence the hidden curriculum so that it reflects the values of dignity, compassion, and moral clarity.
(D) Empathy in a Changing World and Systemic & Societal Contexts
11: Empathy in Technology-Enhanced Care
We recognize that as surgery increasingly integrates robotics, artificial intelligence, and telemedicine, empathy must remain central to patient care. Technology must augment, not replace, human connection and
should be governed transparently to protect patient dignity and clinician accountability.
We resolve to uphold empathy as a guiding principle in all forms of technology-enabled surgical practice.
12: Empathy Across Cultures and Contexts
We acknowledge the diverse cultural, linguistic, and socioeconomic backgrounds of our patients and colleagues. Empathy calls for cultural humility, openness, and respect.
We resolve to practice culturally sensitive empathy that honours the unique context of every individual we serve.
13: Empathy and Social Justice in Surgery
We affirm that empathy sensitizes us, within our professional roles and institutional responsibilities, to disparities in surgical care and encourages ethically grounded efforts toward equity.
We resolve to align empathy with advocacy for fair, just, and equitable surgical care.
(E) Empathy in Clinical Relationships and Adverse Outcomes
14: Empathy with Families and Caregivers
We recognize that surgical decisions and outcomes affect not only patients but also their families and caregivers. Empathy extends to supporting those who stand alongside our patients.
We resolve to engage families and caregivers with compassion, respect, and open communication.
15: Empathy After Adverse Outcomes
We understand that empathy is critical when patients experience harm. Honest disclosure and, where appropriate, sincere apology in accordance with local laws and institutional processes, and a commitment to learning are acts of empathy that support trust. This approach is not intended to impose retrospective moral judgment beyond established clinical, ethical, and legal frameworks.
We resolve to approach adverse outcomes with transparency, humility, and empathic accountability.
We pledge to uphold these values as an unwavering commitment to our patients, colleagues, and society. In doing so, we reaffirm that empathy is a core professional value that meaningfully shapes our identity as surgeons and healthcare leaders. We recognize that this commitment binds us individually and collectively, inspiring us to practice, teach, and advocate for empathy in every aspect of surgical care. We will revisit these commitments through periodic reflection and dialogue within our professional communities.
Endorsements
This Declaration was adopted on 04th December 2025 at the 44th Biennial World Congress of ICS hosted in Singapore and is intended to be applicable across diverse healthcare contexts. It is open for endorsement by surgeons, healthcare professionals, professional associations, academic institutions, and ethics committees. Endorsement does not constitute a legal standard, policy mandate, or claim of constant attainment.