Book contents
- Frontmatter
- Contents
- List of contributors
- Acknowledgements
- 1 Introduction
- Section I Information problems
- Section II End of life care
- Section III Pregnant women and children
- Section IV Genetics and biotechnology
- Section V Research ethics
- Section VI Health systems and institutions
- Section VII Using clinical ethics to make an impact in healthcare
- Section VIII Global health ethics
- Section IX Religious and cultural perspectives in bioethics
- Section X Specialty bioethics
- Introduction
- 56 Surgical ethics
- 57 Anesthesiology ethics
- 58 Critical and intensive care ethics
- 59 Emergency and trauma medicine ethics
- 60 Primary care ethics
- 61 Infectious diseases ethics
- 62 Psychiatric ethics
- 63 Neuroethics
- 64 Pharmacy ethics
- 65 Alternative and complementary care ethics
- Index
- References
57 - Anesthesiology ethics
Published online by Cambridge University Press: 30 October 2009
Book contents
- Frontmatter
- Contents
- List of contributors
- Acknowledgements
- 1 Introduction
- Section I Information problems
- Section II End of life care
- Section III Pregnant women and children
- Section IV Genetics and biotechnology
- Section V Research ethics
- Section VI Health systems and institutions
- Section VII Using clinical ethics to make an impact in healthcare
- Section VIII Global health ethics
- Section IX Religious and cultural perspectives in bioethics
- Section X Specialty bioethics
- Introduction
- 56 Surgical ethics
- 57 Anesthesiology ethics
- 58 Critical and intensive care ethics
- 59 Emergency and trauma medicine ethics
- 60 Primary care ethics
- 61 Infectious diseases ethics
- 62 Psychiatric ethics
- 63 Neuroethics
- 64 Pharmacy ethics
- 65 Alternative and complementary care ethics
- Index
- References
Summary
Mrs. C is an 86-year-old woman with metastatic colon cancer, scheduled for surgery for bowel obstruction. She is hypotensive and tachycardic. She agrees to invasive monitoring but does not want to be resuscitated if her heart stops in the operating room. Her surgeon argues not to place invasive monitors because she is a “no code.”
Mr. D is scheduled to be executed for the rape and murder of a child in the state of Missouri. He appeals his sentence on the grounds that lethal injection subjects the prisoner to potential prolonged suffering during the execution process. A court rules that an anesthesiologist must be present to assure unconsciousness before administration of the paralytic agent and potassium. The ruling states that the anesthesiologist must personally mix the drugs and administer them, or directly supervise their administration.
What is anesthesiology ethics?
Conflicts concerning patient choices and autonomy are particularly challenging in anesthesiology, in part because anesthesia care routinely alters patient consciousness, interferes with patient competence, and restricts or abolishes physical autonomy. Anesthesiologists are at times expected to use their knowledge and skills for the very purpose of abolishing patient resistance. Such expectations present conflicts with core values in the ethical practice of anesthesiology, and of medicine itself. Navigating the complicated course among ethical principles governing patient choice, fulfillment of beneficent intentions, and preservation of professional integrity requires understanding of ethical values and principles such as respect for patient autonomy, beneficence, non-maleficence, preservation of human dignity, promotion of patient safety, and safeguarding of professional integrity.
- Type
- Chapter
- Information
- The Cambridge Textbook of Bioethics , pp. 454 - 461Publisher: Cambridge University PressPrint publication year: 2008
References
, , , et al. (2005). Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 293: 305–10.CrossRefGoogle ScholarPubMed
and (1992). Psychiatry under tyranny: a report on the political abuse of Romanian psychiatry during the Ceausescu years. Curr Psychol 12: 3–17.CrossRefGoogle Scholar
(1994). Statement of the American College of Surgeons on Advance Directives by Patients. “Do not resuscitate” in the operating room. Bull Am Coll Surg 79: 29.Google Scholar
(2000). AMA Opinion 2.06 Capital Punishment. Chicago, IL: American Medical Association.Google Scholar
(2003). The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, Section 1, No. 4. Arlington, VA: American Psychiatric Press.Google Scholar
(1993). Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders, Park Ridge, IL: American Society of Anesthesiologists [amended 2001].Google Scholar
(2003). Guidelines for the Ethical Practices of Anesthesiology. Park Ridge, IL: American Society of Anesthesiologists.Google Scholar
Anderson v. St. Francis–St. George Hospital, Inc. (1996) 617 N.E. 2nd 225 Ohio.
and (1997). Race Discrimination in America's Capital Punishment System since Furman v. Georgia (1972): The Evidence of Race Disparities and the Record of our Courts and Legislatures in Addressing this Issue. Chicago, IL: American Bar Association.Google Scholar
Barber v. Superior Court (1983) 147 Cal App 3d 1006, 195 Cal Rptr 484, 491.
(2001). “To comfort always”: physician participation in executions. J Legisl Pub Policy 5: 47–82.Google ScholarPubMed
(2005). New Claims about Executions and General Deterrence: Deja Vu All Over Again? Los Angeles, CA: University of California Press.Google Scholar
(2005). Killing the willing: “volunteers,” suicide and competency. Michigan Law Rev 103: 939–71.Google Scholar
, , , and (2002). Predictors of survival following in-hospital adult cardiopulmonary resuscitation. CMAJ 167: 343–8.Google ScholarPubMed
and (1997). Overriding a patient's refusal of treatment after an iatrogenic complication. N Engl J Med 336: 1908–10.CrossRefGoogle ScholarPubMed
, , and (1999). Would physicians override a do-not-resuscitate order when a cardiac arrest is iatrogenic? J Gen Intern Med 14: 35–8.CrossRefGoogle ScholarPubMed
(2006). Physician participation in executions: care giver or executioner? J Law Med Ethics 34: 95–104.CrossRefGoogle ScholarPubMed
and (1993). “Do not resuscitate” (DNR) orders and the anesthesiologist: a survey. Anesth Analg 76: 394–401.Google ScholarPubMed
and (1994). “Do not resuscitate” (DNR) orders in the perioperative period: a comparison of the perspectives of anesthesiologists, internists, and surgeons. Anesth Analg 78: 651–8.Google ScholarPubMed
and (1992). The Costs of Processing Murder Cases in North Carolina. Durham, NC: Terry Sanford Institute of Public Policy, Duke University.Google Scholar
Cruzan v. Director, MDH (1990) 497 US 261 US Supreme Court.
(1992). Millions Misspent: What Politicians Don't Say About the High Costs of the Death Penalty, Washington, DC: Death Penalty Information Center.Google Scholar
(2004). Innocence: A Death Penalty Information Center Report. Washington, DC: Death Penalty Information Center.Google Scholar
(2005). Money for Nothing? The Financial Cost of New Jersey's Death Penalty, Trenton, NM: New Jersey Policy Perspective.Google Scholar
(1991). Abuse of psychiatry: analysis of the guilt of medical personnel. J Med Ethics 17: 19–20.CrossRefGoogle ScholarPubMed
, , , , and (2005). Exonerations in the United States 1989 through 2003. J Crim Law Criminol 95: 523–37.Google Scholar
(2006). Message from the President; Observations Regarding Lethal Injection. Highland, Park, IL: American Society of Anesthesiologists.Google Scholar
(1996). The goals of medicine. Setting new priorities: mistaken medical goals and the misuse of medical knowledge. Hastings Cent Rep 26: S1–27.Google Scholar
In the Matter of Quinlan (1976) 70 NJ 10, 355 A.2d.647 Supreme Court of New Jersey.
and (1999). Goals- and values-directed approach to informed consent in the “DNR” patient presenting for surgery: more demanding of the anesthesiologist? Anesthesiology 90: 3–6.CrossRefGoogle ScholarPubMed
(1996). Comprehensive Accreditation Manual for Hospitals: Advanced Directives. Oakbrook Terrace, IL: Joint Commission on Accreditation of Health Care Organizations.Google Scholar
(1993). To help the dying die: a new duty for anesthesiologists? Anesthesiology 78: 225–8.CrossRefGoogle ScholarPubMed
and (2002). Medical aspects of capital punishment executions. J Forensic Sci 47: 847–51.CrossRefGoogle ScholarPubMed
, , , and (2005). Inadequate anaesthesia in lethal injection for execution. Lancet 365: 1412–14.CrossRefGoogle ScholarPubMed
(1992). Professional Liability and the Anesthesiologist. Park Ridge, IL: American Society of Anesthesiologists.Google Scholar
(2001). Death Penalty Ambivalence; Polls Point to Support for Execution Moratorium in US. Philadelphia, PA: International Communications Research, Media.Google Scholar
Lithwick, D. (2006). Does killing really give closure? Washington Post. 24 March, Bo3.
Michael Anthony Taylor v. Larry Crawford et al. (2006). United States District Court Western District of Missouri, Central Division 2:05–cv–04173–FJG, June 26.
, , , et al., (2003). Efficacy of CPR in a general, adult ICU. Resuscitation 57: 43–8.CrossRefGoogle Scholar
(1949). Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10, Vol. 2, Washington, DC: US Government Printing Office, pp. 181–2 (http://www.hhs.gov/ohrp/references/nurcode.htm).Google Scholar
and (1988). Cardiac arrest during anaesthesia. A computer-aided study in 250 543 anesthetics. Acta Anaesthesiol Scand 32: 653.CrossRefGoogle Scholar
Osgood v. Genesys Regional Medical Center (1997), No. 94–267331–NH Circuit Court for Genesee County.
and (2002). The psychological experience of security officers who work with executions. Psychiatry 65: 358–70.CrossRefGoogle ScholarPubMed
, , and (2005). The role of moral disengagement in the execution process. Law Hum Behav 29: 371–93.CrossRefGoogle ScholarPubMed
(1993). Societal duty and moral complicity: the physician's dilemma of divided loyalty. Int J Law Psychiatry 16: 371–91.CrossRefGoogle ScholarPubMed
and (2000). Dubious premises – evil conclusions: moral reasoning at the Nuremberg trials. Camb Q Healthc Ethics 9: 261–274.CrossRefGoogle ScholarPubMed
, , , , and (2002). A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics 109: 200–9.CrossRefGoogle ScholarPubMed
(1979). Soviet abuse of psychiatric commitment: an international human rights issue. Calif West Int Law J 9: 629–53.Google ScholarPubMed
(2003). Do not resuscitate orders and iatrogenic arrest during dialysis: should “no” mean “no”? Semin Dial 16: 395–8.CrossRefGoogle Scholar
(2006). Testimony to the Subcommittee on the Constitution, Civil Rights and Property Rights. Washington, DC: US Senate Committee on the Judiciary.Google Scholar
Schloendorff v. Society of New York Hospital (1914) 211 NY 125; 105 N.E. 92 Court of Appeals of New York.
and (1999). Physician participation in capital punishment: a question of professional integrity. J Urban Health 76: 400–8.CrossRefGoogle ScholarPubMed
, , , and (1999). Capital punishment and deterrence: examining the effect of executions on murder in Texas. Crime Delinquency 45: 481–93.CrossRefGoogle Scholar
, , , et al., (2003). Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: a study of 518 294 patients at a tertiary referral center. Anesthesiology 99: 259–69.CrossRefGoogle Scholar
SUPPORT Principle Investigators (1995). A controlled trial to improve care for seriously ill hospitalized patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). JAMA 274: 1591–8.CrossRef
and (1993). Pain, euthanasia, and anesthesiologists. Anesthesiology 78: 353–60.CrossRefGoogle ScholarPubMed
, , and (1999). DNR in the OR: a goal–directed approach. Anesthesiology 90: 289–95.CrossRefGoogle ScholarPubMed
UN (1949). Geneva Convention Relative to the Treatment of Prisoners of War. [Adopted on 12 August 1949 by the Diplomatic Conference for the Establishment of International Conventions for the Protection of Victims of War, held in Geneva from 21 April to 12 August, 1949. Entry into force 21 October 1950.] Geneva: Office of the United Nations High Commissioner for Human Rights, pp. 1997–2002.
US Department of Justice (2003). Uniform Crime Reports; January to December, 2002. Washington, US Department of Justice, Federal Bureau of Investigation.
US Senate (2005). The Streamlined Procedures Act of 2005, S.1088. United States Senate, 109th Cong., 1st Session.
(1991). DNR in the OR. Resuscitation as an operative risk. JAMA 266: 2407–12.CrossRefGoogle ScholarPubMed
, , , (1997). Patients with DNR orders in the operating room: surgery, resuscitation, and outcomes. SUPPORT Investigators. J Clin Ethics 8: 250–7.Google ScholarPubMed
, , , and (2003). Survival and recovery of consciousness in anoxic–ischemic coma after cardiopulmonary resuscitation. Intens Care Med 29: 1911–15.CrossRefGoogle ScholarPubMed