Based on Henri de Mondeville’s treatise on surgery, this article focuses on his practice and explores the surgeon’s awareness of the concept of charisma and its implications for his professional activities. It seeks to demonstrate the medieval textual continuity of the concept of charisma, its relevance to medieval medical vocation and training, and the fact that charisms remained central to the act of care for this surgeon, who acted for the common good and in fear of divine judgment. This essay looks at possible limiting factors in surgical practice, such as theological issues concerning the body and soul, or the consideration of the notion of moral responsibility. Do charisma, faith, and divine intervention absolve the surgeon from such responsibility? This article will examine whether de Mondeville’s surgical practice was based on predefined principles and non-intervention in the natural order of things or if, on the contrary, the medieval surgeon was accountable for his actions and their consequences independently of divine grace, due to his making a reasoned choice in the context of an ethical approach. This analysis shows that the elements involved in medical decision-making rely on a moral basis, influenced by the Christian religion and normed by religious texts, but do not exclude recourse to an applied code of ethics for specific cases, reserving all freedom of action.