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March 2001
Volume 65 |
Number 3
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| Specialty-Specific
Ethical Issues for the Anesthesiologist |
Stephen H. Jackson,
M.D., Chair Committee on Ethics
Transcending all recorded civilizations
and cultures, the art of healing inevitably has been enveloped
in moral and religious wrappings. The revered Hippocrates emerged
from a Greek civilization in which physicians were priests, yet
he espoused that healing should be a scientific activity based
on observing nature's ability to cure illness. In so doing, he
initiated the separation of medicine from religion, but he also
maintained medicine's attachments to its moral origins.
To this day, physicians abide by Hippocrates'
urging to bestow benefit to their patients while avoiding harm
and injustice, and to care for patients in a moral manner. Accordingly,
medieval guilds, as well as modern medical organizations such
as ASA, have promoted the obligation of the physician to be trustworthy
and reputable as well as competent. Thus, through the millennia,
medical ethics has embodied a relatively unswayed set of moral
admonitions and ideals.
The armamentarium of modern medicine's
capacity to diagnose and treat disease would be largely unrecognizable
by those physicians who practiced when I was a child. Yet our
current body of clinical medicine is destined to change at an
even more accelerated pace. Assuredly, as this new age of medicine
offers the gift of life and health, it concomitantly will challenge
the adequacy of traditional medical morality and ethics. As physicians
strive to benefit patients while avoiding harm, we surely will
encounter the dilemma of not always being certain what constitutes
a benefit and, likewise, a harm.
With this background in mind, members of
the Committee on Ethics in this issue of the NEWSLETTER
have focused on several ethical issues of specific interest to
our specialty, ones generated by the special skills that anesthesiologists
possess. R. Dennis Bastron, M.D., and Robert J. McQuillan, M.D.,
begin by looking at the yearly affirmation required of all ASA
members to abide by the Guidelines for the Ethical Practice of
Anesthesiology. 1
Gail A. Van Norman, M.D., and Susan K. Palmer, M.D., then follow
with a discussion of restraint and coercion as these relate to
the ethical obligation of the anesthesiologist to the uncooperative
patient. Indeed, the Committee on Ethics has agreed that anesthesiologists
should not use their skills to restrain or coerce competent patients,
and shall be recommending incorporation of this statement into
the guidelines. Carl C. Hug, Jr., M.D., Ph.D., follows by sharing
thoughts he conveyed in the 1999 E. A. Rovenstine Memorial Lecture
on intervention in patients near the end of life. 2
David B. Waisel, M.D., and Robert D. Truog, M.D., conclude by
presenting information for the ethical management of patients
with existing do-not-resuscitate orders who present for anesthesia
and surgery. 3, 4
| As physicians
strive to benefit patients while avoiding harm, we surely
will encounter the dilemma of not always being certain what
constitutes a benefit and, likewise, a harm. |
References:
1. ASA Standards, Guidelines
and Statements. Park Ridge, IL: American Society of Anesthesiologists;
2000.
2. Hug C Jr. Patient values,
Hippocrates, science, and technology: What we (physicians) can
do versus what we should do for the patient. Anesthesiology. 2000;
93:556-564.
3. Truog RD, Waisel DB,
Burns JP. DNR in the OR: A goal-directed approach. Anesthesiology.
1999; 1:289-295.
4. Jackson SH, Van Norman
GA. Goals- and values-directed approach to informed consent in
the DNR patient presenting for surgery. Anesthesiology. 1999;
1:3-6.
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Stephen
H. Jackson, M.D., is Staff Anesthesiologist and Chair of the
Bioethics Committee at Good Samaritan Hospital, San Jose,
California. |
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