From pre-operative preparation and risk assessment to post-operative follow-up, anesthesiologists have a unique position in that they interact with patients across a broad spectrum of care. In addition to this breadth, they also deal with the full depth of medical challenges and discomfort. When patients find themselves in their most vulnerable moments—whether it be in severe pain or liminal consciousness—an anesthesiologist is consistently involved and often attending directly to that experience.
It should come as no surprise that this profession is historically ahead of the curve when it comes to the ethical practice of their profession. In a previous post, we discussed the historical origins of that tradition. This post answers the question: what are the fundamentals of the ethics of anesthesiology?
When discussing any kind of ethics, two primary components come to mind. First, there are the ideals that inform our definitions and understandings of ethical issues. These are concepts and principles that animate the discussions around professional ethics and they are fundamental to whatever case we may be focused on. Secondly, professional ethics have a pragmatic component that is concerned with the day-to-day of practicing something ethically. When complex situations arise, as they often do for anesthesiologists, professional ethics can provide a framework to direct choices and actions. What are the on-the-ground questions and problems faced by anesthesiologists, and what do our ideals prompt us to answer?
First, it is helpful to understand what kinds of pragmatic issues arise for the practice of anesthesiology. The unique issues at play can be organized into three central categories: preoperative, intraoperative, and post-operative. Preoperatively, anesthesiologists may sometimes find their expert consultation on a patient’s fitness for surgery to be at odds with the surgeon or other physicians. They may also encounter questions around the informed consent process, and whether it adequately assesses a patient’s understanding and acceptance of the procedure. Intraoperatively, anesthesiologists may find themselves in a unique position to advocate for a patient to be treated with respect and modesty. This engages complex dynamics and roles between different clinicians involved with surgery, but no one understands better than an anesthesiologist the particularly vulnerable position of a patient who is under. Post-operatively, anesthesiologists may face challenges ensuring that a patient is transitioned well to their treatment and recovery plan.
When considering these potentially thorny issues, universal ethical principles can enter and help to shape an approach for day-to-day ambiguities that arise.The ideals of ethical anesthesiology practice include the following principles. These are included among the broader code of ethics defined by the American Medical Association:
Intuitively, anesthesiologists hold a deep responsibility to the patients that they serve.
Anesthesiologists are ethically accountable to the facilities where they practice and their colleagues. This is an especially important principle for a medical specialty known for the frequent and broad collaboration required in this role.
Anesthesiologists must conduct themselves ethically in their treatment of themselves. This principle speaks to the importance of a clinician who tends to her own health and well being to ensure the best possible treatment for her patients.
At the highest level, anesthesiologists hold a responsibility to society. This principle, perhaps more so than any of the others, demonstrates that anesthesiologists do not exist in isolation—the ethical practice of anesthesiologists is defined in relation to many levels: their patients, colleagues, communities, and to themselves.
These central principles, when applied to the issues in the field, encourage problem-solving that looks holistically at every actor, not just the individual.
References
Hariharan, Seetharaman. “Ethical issues in anesthesia: the need for a more practical and contextual approach in teaching.” Journal of anesthesia 23.3 (2009): 409-412.
GUIDELINES FOR THE ETHICAL PRACTICE OF ANESTHESIOLOGY, Committee of Origin: Ethics (Approved by the ASA House of Delegates on October 15, 2003, and last amended on October 22, 2008)