Surgical practice relies on the operator's skills, knowledge, and judgment. Surgeons often face situations that challenge their moral choices and ethical dilemmas in their daily practice. The continuous and sometimes rapid development of technologies allows for increasingly complex surgeries; as this occurs, the risks become greater, and the tools needed to address an ethically challenging case become more relevant. Surgical ethics can be distinguished from other fields of medical ethics due to its unique characteristics and objectives. A competent surgeon is not only capable of practicing the art and science of surgery as traditionally understood but is also ethically and morally trustworthy. The aim of this manuscript was to summarize information regarding some ethical dilemmas in surgical practice. It begins with the development of some historical aspects, and then explores elements related to informed consent, the paradigm of shared decision-making in surgical practice, the role of confidentiality in the surgeon-patient relationship, the obligations and regulations of surgical practice, some behavioral aspects, as well as the performance of unnecessary surgeries.