Ethical Approaches to the Practice of Anesthesiology - Part 1: Overview of Ethics in Clinical Care: History and Evolution, An Issue of Anesthesiology Clinics

1st Edition, Volume 42-3 - July 24, 2024
Author: Elsevier Clinics
Editors: Neal H. Cohen, Gail Van Norman
Language: English
Hardback ISBN:
9 7 8 - 0 - 4 4 3 - 2 4 6 7 8 - 4
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 2 4 6 7 9 - 1

In this issue of Anesthesiology Clinics, guest editors Drs. Neal H. Cohen and Gail van Norman bring their considerable expertise to the topic of Ethical Approaches to the Practice… Read more

Ethical Approaches to the Practice of Anesthesiology - Part 1: Overview of Ethics in Clinical Care: History and Evolution, An Issue of Anesthesiology Clinics

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In this issue of Anesthesiology Clinics, guest editors Drs. Neal H. Cohen and Gail van Norman bring their considerable expertise to the topic of Ethical Approaches to the Practice of Anesthesiology - Part 1: Overview of Ethics in Clinical Care: History and Evolution. In this first of a two-part series, top experts discuss topics such as the role of advance directives and living wills on anesthesia practice; preoperative care of the patient with DNR orders; end-of-life care: withdrawing/withholding support; brain death: medical, ethical, cultural, legal aspects; ethics consult in anesthesia practice; and more.

Cover image
Title page
Table of Contents
Copyright
Contributors
Forthcoming Issues
Foreword
Preface
Managing the Labyrinth of Complex Ethical Issues in Anesthesia Practice: The Anesthesiologist’s Ariadne’s Thread
Key points
Lost in ethical dilemmas
Mandatory training, not personal character
Common morality and the Georgetown Mantra
Cross-cultural bioethics
“To act or not to act”
Informed consent: not merely a signed form
Appropriateness and proportionality
Not everything that is permitted is honorable
Join forces, share the burden!
Medicine, not mathematics
The dual-role experience of clinician-researchers and research ethics
Summary
The Evolution of the Ethical Guidelines of the American Society of Anesthesiologists
Key points
Introduction
American Society of Anesthesiologists guidelines for the ethical practice of anesthesiology
American Society of Anesthesiologists guidelines for anesthesia care of patients with do-not-resuscitate orders or other directives limiting care
The American Society of Anesthesiologists Committee on Ethics responds to clinical events
Summary
Clinics care points
The role of Advance Directives and Living Wills in Anesthesia Practice
Key points
Introduction
Preoperative planning: the role of the perioperative provider in advance directives
Clinical outcomes: implications of LSMT on postoperative morbidity and mortality
Current practice and adherence to guidelines
Future directions: patient-centered outcome data
Future directions: perioperative physician training
Future directions: improving quality and consistency of care
Summary
Clinics care points
Perioperative Care of the Patient with Directives Limiting Life-Sustaining Treatments
Key points
Introduction
Longitudinal considerations
Preoperative and planning phase
Perianesthesia phase
Postprocedural care
Summary
Clinics care points
End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
Key points
Introduction
Discussion
Summary
Critics care points
Brain Death: Medical, Ethical, Cultural, and Legal Aspects
Key points
Background
Discussion
Summary
Clinics care points
Ethics Consultation in Anesthesia Practice
Key points
Introduction
The perioperative ethics consultation
The context of ethics consultation in anesthesia practice
Summary
Clinics care points
Public Good versus Private “Goods”: Ethical Implications of Drug Shortages on Anesthesiology Practice
Key points
Introduction
The nature of ethics and the structure of ethical adjudication
Deontology and utilitarianism
Ethical rationing
How do drug shortages impact health care as a right rather than a privilege?
Drug shortages—public goods and private goods
Market incentives should drive in the direction of robust supply (impact of anti-kickback legislation)
Addressing the drug shortage through the gray market
Fair distribution policies are insufficient to eesolve the fundamental problem of a lack of supply
A robust and fair compensated generic drug market is as important as the drive toward innovation in the branded drug market
The bioethical imperative to act
Clinics care points
Medical Triage: Ethical Implications and Management Strategies
Key points
Introduction
Definitions, objectives, ethics, and challenges
Critical elements of triage protocols
Perspectives of different groups
The human factor, trainings, and simulations
Lessons learned from recent catastrophes
Summary
Clinics care points
Ethics of Preanesthesia Mandatory Laboratory Testing
Key points
Introduction
Evidence based medical tests
Informed consent and laboratory testing
Preanesthesia pregnancy testing
Medico-legal liability concerns
Mandatory COVID-19 testing: example of a changing landscape and changing ethics
Clinics care points
Maternal–Fetal Conflicts in Anesthesia Practice
Key points
Introduction
Case study #1: neuraxial versus general anesthesia
Case study #2: pain during cesarean delivery
Case study #3: fetal surgery
Summary
Clinics care points
Ethical Care of Pregnant Patients During Labor, Delivery, and Nonobstetric Surgery
Key points
Introduction
Definitions
Terminology
Ethical issues during labor and delivery
Summary
Clinics care points
Ethical Issues in the Care of Patients Whose Personal, Religious, or Cultural Beliefs Impact Clinical Management Strategies
Key points
Introduction
Religious and cultural overview of select patient populations
Ethical principles
Legal precedents
Issues to consider when patients have personal or religious beliefs impacting clinical management
Discussion
Clinics care points
Disclosure of Adverse Events and Medical Errors: A Framework for Anesthesiologists
Key points
Introduction
Historical context
The advantages and opportunities associated with disclosure of adverse events and medical errors
Challenges of disclosure and the “disclosure gap”
Error disclosure in the context of anesthesiology practice
Malpractice legislation
Communication and resolution programs
Risk management best practices
Communication strategies and training
Culture of safety, and root cause analysis
Summary
Clinics care points
Conscientious Objection
Key points
Introduction
Conscience and objection
Accommodating conscientious objections
Legislative issues
Summary
Clinics care points

Life Sciences

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Ethical Approaches to the Practice of Anesthesiology - Part 1: Overview of Ethics in Clinical Care: History and Evolution, An Issue of Anesthesiology Clinics

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Neal H. Cohen

Gail Van Norman