ethical issues in anaesthesia

8/2/2019 Ethical Issues in Anaesthesia

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Ethical Issues in Medicine

Dr. E. McIntosh

April 06


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Ethics

A set of principles of right conduct.

A theory or a system of moral values

1. ethics(used with a sing. verb) The study of the generalnature of morals and of the specific moral choices to be

made by a person; moral philosophy.

2. ethics(used with a sing. or pl. verb) The rules orstandards governing the conduct of a person or themembers of a profession: medical ethics.

(Greek ethika, from ethos: character, custom)


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Theories of Ethics

Utilitarianism

An action should be done if it leads to the best

possible outcome for the most people

Deontology

Certain actions are right or wrong regardless of

the outcome


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Principles of Medical Ethics

Beneficence

Nonmaleficence

Respect for Autonomy

Distributive Justice

Beauchamp TL, Childress JF: Principles of Biomedical Ethics. NewYork, Oxford University Press, 1994, pp 121.


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Beneficence

Doing goodobligation to do whats best

for the patient

Preservation of life

Restoration of health

Relief of suffering

Restoration or maintenance of function


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Nonmaleficence

Primum non nocere above all do no harm

Avoiding anything that may affect the patient

adversely Therapies or intervention with known dangerous side

effects

Interventions of unproven benefit

Interventions with which the practitioner is unfamiliarwith or unskilled in


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Respect for Autonomy

Respects patients right to self-

determination

Largely a western philosophy, may not apply inother cultures.

Patients right to consent to or to refuse

treatment. Basis for informed consent


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Distributive Justice

Principle of Fairness, giving to each person

what he deserves.

Relates to allocation of health care

resources.

Every patient has a right to best possible

health care without regard to race, socialstanding, religion, etc.


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Ethical Dilemmas

Morally obligated to do two differentactions but unable to do both.

Physician and patient/proxy in conflict as towhat is best for the patient.

When if ever, can patients rights/wishes be

overruled? Resource limitationswho gets what? Who

decides?


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Ethical Analysis

Who decides?

By what criteria?

How are conflicts among decision-makers

resolved?

How is conflict prevented?


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Principles of Ethical Analysis

Medical Indications

Nature of medical problem, goals of treatments,complications, etc.

Patient Preferences

Pts right to choose, informed consent etc.

Quality of Life

Impact of treatment/non-treatment Contexual features

Religious, family, financial, cultural etc.


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Making Decisions

Make a decision in perceived best interest

of patient and inform them of decision?

Give patient the facts and let them decide?

Give patient the facts and recommend a

course of action?

What if patient wants to proceed against

advise?


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Ethical Decision Making

Determine whether the issue at hand is an ethical

one

Consult authoritative sources such as medicalassociation codes of ethics and policies and

respected colleagues to see how physicians

generally deal with such issues

Consider alternative solutions in the light of the

principles and values they uphold and their likely

consequences


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Ethical Decision Making cont.

Discuss your proposed solution with thosewhom it will affect

Make your decision and act on it, with duesensitivity to others affected

Evaluate your decision and be prepared to

act differently in future

WMA Medical Ethics Manual 2005


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Elements of Informed Consent

Competence: ability to make rational

decisions

Adequate disclosure of informationRisks, benefits, consequences and alternatives

Understanding of information

Voluntariness: patient decides of own freewill, no coersion

Authorization: patient gives consent


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Informed Consent for Minors

Age of consent

Parent or guardian responsible

Child still needs to participate in the process ofinformed consent

Give explanations and allow choices appropriate forage and maturity.

Conflicts Emergency situations, no relatives available

Parent/guardian refuses consent for life savingtreatment.


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Confidentiality

Prohibit disclosing patient information

without patients consent

Mandates precautions to preventunauthorized access to patient information

Exceptions

Concern for safety of other specific persons

Concern for public welfare


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Advanced Directives

Usually relates to end of life issues, palliative care,

certain religious beliefs, etc.

Living wills Patient determines in advance what is to done if he

becomes incapable of making decisions.

Appointment of proxy or surrogate

Person designated to make decisions on patients behalf

if he should lose the ability to make his own decisions


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Refusal of Treatment

Competent adult has the right (autonomy)

Conflict for many health care workers

Incompetent adult or minorwho decides?Advanced directive of previously competent

adult

Parents/guardian of minors, incompetent adult

Courts

Aim to do what is in best interest of the patient.


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DNR Orders

Resuscitation considered futile or inappropriate in

light of patients prognosis

Must take into consideration patients expressed

wishes

Must be discussed with patient/proxy and relatives

Conflict

Patient/relative disagree with doctor Relatives/spouses/surrogates disagree with each other

When to suspend DNR order


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Discontinuation of Life

Sustaining Treatment Brain death

Persistent vegetative state

Multiple irreversible organ failure: futile treatment

Conflicts

Definitions: Death, futile care

Definition of treatment When can treatment be ethically discontinued?

Who decides?


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Euthanasia and Assisted Suicide

Active intervention to end life of a person whowould not otherwise die

Usually persons suffering with intractable pain Advanced cancer

End-stage heart or lung disease

Quadriplegics Ethical and spiritual issues

Illegal in most places


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Rights of the Physician

Right to respect and courtesy

Right to act in accord with his own

conscience or moral beliefs

Right to refuse involvement in situations

which conflict with his own ethical or moral

beliefs

ethical issues in anaesthesia

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