Due to the inherently trust-based nature of surgery in which most patients are under anesthesia, surgeons’ professional responsibility to patients and society transcends what is readily visible. Because surgical ethics is neither absolute nor external, we have the opportunity and the obligation to shape surgical ethics to align with evolving societal expectations and professional obligations. This chapter will examine some of the most pressing ethical concerns of surgical practice today, with particular attention given to how these concerns relate to the humanistic interests of patients, surgeons, and society. We will consider the tenets of the social contract that form the basis for how we consider our role as professionals, and we will investigate whether the evolution of these precepts has implicitly given rise to a yet unnamed but frequently practiced tacit agreement between surgeons and society. We will analyze with case scenarios the theoretical and applied implications of these novel trends in surgical ethics. Finally, we will explore the intersection of surgery’s leading role in innovation and socioeconomic disparities, using a humanistic lens to showcase the modern-day social contract.