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September 2002
Volume 66 |
Number 9
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FAER REPORT
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Anesthesia's Emergency Room
Sean K. Kennedy, M.D.
Foundation for Anesthesia Education and Research Board of
Directors
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Although there was much discussion over the exact wording of
our mission statement, all agreed that our focus is on education
and research – the "ER" in FAER. In Orlando this
October, FAER continues its two-pronged efforts at highlighting
research and educating physicians.
On Monday, October 14, at 2 p.m., James C. Eisenach, M.D., will
deliver the FAER Honorary Research Lecture – the "R"
in FAER. Immediately following that talk comes the "E"
in FAER – the annual FAER panel discussion, this year titled
"Anesthesiology and Palliative Medicine – Is It Part
of Our Mission?" (Panel members are listed below.)
The panel's goal is to help educate the anesthesiology community
about an increasingly important but largely hidden area of medical
practice: palliative medicine. Great strides in medical care have
meant longer survival times from illnesses that once brought quick
mortality. In some cases, we have seen cure; in other cases, longer
survival but reduced quality of life. The rapid growth of hospice
care is one inevitable result. What should be the role of anesthesiology,
if any, in this field?
For many patients, the major determinant of "quality of
life" during the terminal phase of an illness is pain. Pain
becomes the dominant force in the terminal patient's life, and
the will to live then depends on pain relief. With adequate pain
control, issues of assisted suicide may become moot; poorly controlled
pain creates despair that leads to such a request. With adequate
pain control, patients can die on their own terms. Many say they
want to die at home, not in a hospital, but pain stands in the
way. The pain doctor becomes the most important physician in this
patient's life. Who should that doctor be?
Palliative medicine requires a whole different orientation to
success. We are used to a cure equaling success and death symbolizing
failure. Now that death is inevitable in the short term, the focus
must shift to quality of life, a shift not easily made by many
physicians, including anesthesiologists. In addition, we are in
the midst of a growing shortage of trained anesthesiologists in
the operating room, a situation that would be made worse by siphoning
off some to nonsurgical practice. Is this the right time to expand
the specialty into yet another nonoperating room site?
The FAER panelists will tackle these issues and more that always
come from the audience. Our goal is to educate, to look at all
sides of this complex issue from the perspective of physicians
who are on the "front line." Palliative medicine is
still in its formative stage, and anesthesiology's involvement
has yet to be defined. This is the time for a thoughtful, comprehensive,
in-depth discussion of anesthesia and palliative medicine. Is
it part of our mission?
Members of FAER Panel on Anesthesiology and Palliative Medicine
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Daniel B. Carr, M.D., Tufts University
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Perry G. Fine, M.D., University of Utah
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Mark J. Lema, M.D., Ph.D., University at Buffalo, State
University of New York
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Ronald D. Miller, M.D., University of California-San Francisco
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