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Devin
Student
Arlington, Texas
1
Question
Updated
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What ethical challenges are unique to anesthesiology, and how do practitioners navigate situations where rapid decisions must be made under pressure? #Spring26
I am a college freshman planning to pursue a career in anesthesiology after medical school, and I want to better understand what to expect in the field and how to effectively handle situations I may face in my future career.
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James Hanson
Pediatric Intensive Care Physician; Consultant
266
Answers
Oakland, California
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James’s Answer
As you go through medical school and then residency, you will certainly learn a lot about how to navigate the ethics and legal aspects of anesthesiology. All physicians learn about the laws and regulations related to the practice of medicine and that relate to human research trials.
Key points are to be clear and complete in discussing and documenting recommended plan of care, with risks, benefits, and alternatives. Even though anesthesiology has developed a remarkable safety record, one still always admits to the real risks of death and disability that depend on the type of anesthesia provided.
When one is careful to listen to the goals of care for each patient and has discussed what should be done if things don't go smoothly, you don't have much ethical issues come up.
As a pediatric intensivist, I had similar challenges. Most commonly, loved ones wanting you to do something that is medically futile or against the wishes already voiced by the patient or their decision-maker. It is unethical to circumvent the autonomy of each patient, and we always look at the beneficence and nonmaleficence (do what is helpful and avoid things that do harm) ratio. "Justice" is another ethical construct that relates to how just is may be to, for example, provide an extraordinarily expensive treatment that has only a tiny chance of being helpful - especially if providing that benefit may make it less available to other patients. Should one put a patient who has profound brain injury on extracorporeal membrane oxygenation when that may make the machine unavailable for a patient likely to benefit from it after heart surgery?
Anesthesiology can be a bit lonely, but you really are a part of a team, and learning to share thoughts as a team to come up with agreements about what to do helps a lot.
Key points are to be clear and complete in discussing and documenting recommended plan of care, with risks, benefits, and alternatives. Even though anesthesiology has developed a remarkable safety record, one still always admits to the real risks of death and disability that depend on the type of anesthesia provided.
When one is careful to listen to the goals of care for each patient and has discussed what should be done if things don't go smoothly, you don't have much ethical issues come up.
As a pediatric intensivist, I had similar challenges. Most commonly, loved ones wanting you to do something that is medically futile or against the wishes already voiced by the patient or their decision-maker. It is unethical to circumvent the autonomy of each patient, and we always look at the beneficence and nonmaleficence (do what is helpful and avoid things that do harm) ratio. "Justice" is another ethical construct that relates to how just is may be to, for example, provide an extraordinarily expensive treatment that has only a tiny chance of being helpful - especially if providing that benefit may make it less available to other patients. Should one put a patient who has profound brain injury on extracorporeal membrane oxygenation when that may make the machine unavailable for a patient likely to benefit from it after heart surgery?
Anesthesiology can be a bit lonely, but you really are a part of a team, and learning to share thoughts as a team to come up with agreements about what to do helps a lot.