In a previous post, we wrote about how the field of anesthesiology has a rich history of engaging with ethical issues that arise in medical practice. But what are the ethics of anesthesiology practice? What defines an ethical anesthesiologist?
There are two major dimensions to consider when discussing ethics. First and foremost 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 are fundamental to whatever case we may be focused on. Then, there is also the pragmatic dimension of ethics: what ought to be done in complicated situations? What are the on-the-ground questions and problems faced by anesthesiologists, and what do our ideals prompt us to answer? Universal ethical principles help to shape an approach that we can then apply to the day-to-day ambiguities that arise.
Like most medical specialties, anesthesiology has a code of ethics defined through rigorous discussion and consensus among leaders in the field. They fall under the broader Principles of Medical Ethics as defined by the American Medical Association. Those principles include the familiar “do no harm,” as well as other general values that most physicians share. Particular to anesthesia are a set of compelling guidelines that all patients may expect when under the care of an anesthesiologist.
Anesthesiologists have an ethical responsibility towards not only their patients, but also the facilities where they practice, their clinical colleagues, and to themselves. This means supporting a patient’s self-determination and including them in the choices around their care when appropriate. Anesthesiologists must treat all patients indiscriminately, employing respect and adhering closely to safety protocols. Among colleagues, anesthesiologists are committed to collaborating thoughtfully to improve quality, effectiveness and efficiency of medical care. Importantly, anesthesiologists must also take good care of themselves to ensure their own physical and mental health to perform in this often demanding job.
According to their code of ethics, anesthesiologists also share an ethical responsibility to society as a whole. This means participating in activities that serve and improve their communities, and acting as a positive representation of their profession in any capacity.
As you can see, anesthesiology does not exist in isolation—the ethical practice of anesthesiologists is defined in relation to many levels: their patients, colleagues, communities, and to themselves. This central framework, when applied to the issues in the field, encourage problem-solving that looks holistically at every actor, not just the individual.
Thinking pragmatically, anesthesiologists face many complicated and current questions in this time of innovation and growth. 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.
The anesthesiologist holds a very unique position, both in the operating room and in the medical field generally. Their roles, expertise, and experiences are particular to the specialty and accordingly follow specific principles to guide the ethical practice of their work. This ensures not only their efficacy on a case-by-case basis, but also an integrated effort across many cooperating clinicians to create a safe and high-quality environment of care.
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)