Perioperative Medical Ethics and the Anesthesiologist

Medicine is above all a moral endeavor. Anesthesiologists are tasked with evaluating the overall medical condition of the patient not just performing a scheduled procedure – they are the primary care physicians in the perioperative period. This is becoming even more so since physicians are most often employees of large healthcare delivery systems. These systems view patients as objects that must be put through the system quickly to optimize profits. Currently, proceduralists and/or surgeons are only responsible for the technical aspects of their procedure; the care of the patient is the anesthesiologist’s problem. Anesthesiologists have an ethical duty to put the patient’s interests foremost. Often this places them in conflict with surgeons and the healthcare system who perceive anesthesiologists as hindering through-put and interfering with profit. Anesthesiologists are given a perfunctory period in which they have to establish a relationship with the patient, determine the patients’ wishes, and obtain informed consent. The basis for understanding the ethical foundations of the processes involved is discussed in this chapter.

Keywords: Adequate Disclosure, Autonomous Authorization, Advanced Directives, Competency, Consent Elements, Decision, Decision Making Capacity, DNR/DNAR (Do Not Resuscitate, Do Not Attempt Resuscitation), Double Effect, Euthanasia, End of Life Care, Informed Consent, Living Wills, Principlism, Personal Autonomy, Power of Attorney for Healthcare Proxy, Physician Assisted Suicide, Palliative Care, Senilicide, Shared Decision Making, Substituted Judgment, Treatment Futility, Treatment Redirection, Voluntarism.