Chapter 197: Ethical Issues

BASIC PRINCIPLES OF MEDICAL ETHICS

When making decisions regarding patient care, the anesthesiologist, as the provider of medical care, should demonstrate respect and honesty for the patient. The ethical practice of anesthesiology is based on the following guiding principles:

1. Nonmaleficence—Anesthesiologists abide by the doctrine of “do no harm” to their patients. However, sometimes a treatment, such as providing general anesthesia for an operation, can unintentionally lead to harm, such as cardiac arrest due to hypoxemia, when the intention was for good. Successful application of this principle may be difficult.

2. Autonomy—The patient is an independent being who can make fully informed decisions regarding his or her own health care. They have the right to accept or refuse diagnostic or therapeutic interventions. A full informed consent is necessary for the competent patient to understand risks and benefits, and to achieve autonomy. Coercion is unethical, even if the patient’s decision may not be in his or her best medical interest.

3. Justice—Anesthesiologists should be fair when providing their services to surgical patients. All members of society deserve to receive medical resources, no matter how scarce. When considering the principle of justice, physicians should evaluate a patient’s legal rights as well as possible conflicts with local laws.

4. Beneficence—While the principle of nonmaleficence is based on “do no harm,” beneficence requires physicians to “do good” for the patient in every situation. Anesthesiologists should evaluate each patient’s individual situation and not apply the same blanket decision for everyone. To do so, physicians must maintain their skills and update their medical knowledge on a regular basis.

GUIDELINES FOR THE ETHICAL PRACTICE OF ANESTHESIOLOGY

The American Society of Anesthesiologists (ASA) has published a set of guidelines for the ethical practice of anesthesiology. Revised in 2011, they can be found on the ASA website at http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx. Although this document outlines important principles, every anesthesiologist should make individualized decisions for each patient. The basic guidelines are as follows:

Anesthesiologists have Ethical Responsibilities to Their Patients

1. The patient–physician relationship involves special obligations for the physician that include placing the patient’s interests foremost, faithfully caring for the patient and being truthful.

2. Anesthesiologists respect the right of every patient to self-determination. Anesthesiologists should include patients, including minors, in medical decision making that is appropriate to their developmental capacity and the medical issues involved. Anesthesiologists should not use their medical skills to restrain or coerce patients who have adequate decision-making capacity.

3. Anesthetized patients are particularly vulnerable, and anesthesiologists should strive to care for each patient’s physical and psychological safety, comfort, and dignity. Anesthesiologists should monitor themselves and their colleagues to protect the anesthetized patient from any disrespectful or abusive behavior.

4. Anesthesiologists should keep confidential patient’s medical and personal information.

5. Anesthesiologists should provide preoperative evaluation and care, and should facilitate the process of informed decision making, especially regarding the choice of anesthetic technique.

6. If ...