Ethical Questions in Anesthesiology

In its nearly 170-year history in the US, anesthesiology has expanded far beyond the operating room into obstetrics, pain management, critical care, and the full range of perioperative care. The specialty’s growth has brought complex ethical questions with it. Contributors to the March issue of the AMA Journal of Ethics examine some of those concerns—the use of opioids and the effects of bias in pain treatment; challenges to interspecialty professionalism, particularly in operating room and critical care settings; and the ability of seriously ill patients to give fully informed consent to (or refusal of) extracorporeal life support.

Volume 17, Number 3: 191-286 Full Issue PDF
  • From the Editor
    Mar 2015

    Ethics and the Practice of Anesthesia

    Matthew L. Edwards
    With their expertise in physiology, pharmacology, and resuscitation, anesthesiologists made essential contributions to the development of critical care medicine.
    AMA J Ethics. 2015;17(3):199-201. doi: 10.1001/journalofethics.2015.17.3.fred1-1503.
  • Case and Commentary
    Mar 2015

    Opioids for Nonmalignant Chronic Pain

    Anna Woodbury, MD
    Given full information about the risks of long-term opioid therapy, patients often see the value of exploring other options rather than thinking their physicians are reluctant to prescribe narcotics for fear of litigation or regulatory action.
    AMA J Ethics. 2015;17(3):202-208. doi: 10.1001/journalofethics.2015.17.3.ecas1-1503.
  • Case and Commentary
    Mar 2015

    Withholding Information from an Anxiety-Prone Patient?

    Katherine L. Zaleski, MD and Davi B. Waisel, MD
    Withholding information from patients during an informed consent process is ethically unacceptable. Patients may restrict the amount of information they wish to receive or designate someone else to receive the information for them.
    AMA J Ethics. 2015;17(3):209-214. doi: 10.1001/journalofethics.2015.17.3.ecas2-1503.
  • Case and Commentary
    Mar 2015

    Abusive and Disruptive Behavior in the Surgical Team

    Gail A. Van Norman, MD
    Mean, abusive, and disruptive behavior among physicians interferes with teamwork and may result in decreased patient safety. Therefore, it must be discouraged through reinforcement of appropriate behavioral norms.
    AMA J Ethics. 2015;17(3):215-220. doi: 10.1001/journalofethics.2015.17.3.ecas3-1503.
  • Medical Education
    Mar 2015

    Education to Identify and Combat Racial Bias in Pain Treatment

    Brian B. Drwecki, PhD
    Reducing racial disparities in pain treatment requires an interdisciplinary approach to identifying causes of racial biases and teaching health care professionals to recognize and reduce them.
    AMA J Ethics. 2015;17(3):221-228. doi: 10.1001/journalofethics.2015.17.3.medu1-1503.
  • In the Literature
    Mar 2015

    Perioperative Do-Not-Resuscitate Orders

    Stephen Jackson, MD
    Although there are valid reasons to suspend do-not-resuscitate (DNR) orders during surgery, the decision to do so should be discussed with patients and should take into account their goals and objectives.
    AMA J Ethics. 2015;17(3):229-235. doi: 10.1001/journalofethics.2015.17.3.nlit1-1503
  • State of the Art and Science
    Mar 2015

    Is Informed Consent for Extracorporeal Life Support Even Possible?

    Allan B. Peetz, MD, Nicholas Sadovnikoff, MD, and Michael F. O’Connor, MD
    Because of their serious medical conditions and the nature of the treatments, patients who are candidates for extracorporeal life support may not be able to give properly informed consent for the treatment.
    AMA J Ethics. 2015;17(3):236-242. doi: 10.1001/journalofethics.2015.17.3.stas1-1503
  • State of the Art and Science
    Mar 2015

    Ethical Tenets of Perioperative Care: “Finding My Surgical Way Home”

    Jason D. Hall, JD, Lee A. Goeddel, MD, MPH, and Thomas R. Vetter, MD, MPH
    In the perioperative surgical home, the anesthesiologist coordinates care with other team members to provide seamless continuity from preoperative evaluation to postoperative care.
    AMA J Ethics. 2015;17(3):243-247. doi: 10.1001/journalofethics.2015.17.3.stas2-1503.
  • Policy Forum
    Mar 2015

    Quality Improvement and Patient Safety Organizations in Anesthesiology

    Richard P. Dutton, MD, MBA
    The Anesthesiology Quality Institute contributes both to local quality improvement in the practice of anesthesiology through data collection and establishment of benchmarks and to patient safety in partnership with the Anesthesia Patient Safety Foundation.
    AMA J Ethics. 2015;17(3):248-252. doi: 10.1001/journalofethics.2015.17.3.pfor1-1503.
  • Medicine and Society
    Mar 2015

    The Influence of Social Values on Obstetric Anesthesia

    Donald Caton, MD
    The first women’s movement in the mid-nineteenth century endorsed anesthesia during childbirth and some of the very patterns of obstetric practice that became anathema to the natural childbirth movement a century later.
    AMA J Ethics. 2015;17(3):253-257. doi: 10.1001/journalofethics.2015.17.3.msoc1-1503.
  • History of Medicine
    Mar 2015

    The History of Professionalism in Anesthesiology

    Kathryn E. McGoldrick, MD
    Anesthesiology developed into a profession in the first third of the twentieth century with the establishment of professorships, training programs, board certification, and journals in anesthesiology and advances in delivering and in understanding the effects of anesthesia.
    AMA J Ethics. 2015;17(3):258-264. doi: 10.1001/journalofethics.2015.17.3.mhst1-1503.
  • Viewpoint
    Mar 2015

    The Importance of Good Communication in Treating Patients’ Pain

    Anita Gupta, DO, PharmD
    Effective patient-physician communication requires that the physician show empathy, express concern, be sensitive to nonverbal communication, and, more generally, follow the Golden Rule.
    AMA J Ethics. 2015;17(3):265-267. doi: 10.1001/journalofethics.2015.17.3.sect1-1503.
  • Viewpoint
    Mar 2015

    Disagreements between Medical Specialty Boards and their Diplomates

    David B. Waisel, MD
    Medical specialty boards improve the quality and safety of health care, but they can overreach, and their board members express disapproval of board action by petition and through legal action.
    AMA J Ethics. 2015;17(3):193-198. doi: 10.1001/journalofethics.2015.17.3.spec1-1503.
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    Podcast
    Mar 2015

    Ethics Talk: Anesthesiology’s Contributions to Medicine

    This month, AMA Journal of Ethics theme editor Matthew Edwards, a third-year medical student at the University of Texas Medical Branch School of Medicine, interviewed Douglas R. Bacon, MD, MA, on the development of anesthesiology and the "balanced anesthesia" approach.