The medical profession has long subscribed to a body of ethical statements developed primarily for the patient’s benefit. As a member of this profession, a physician must recognize the responsibility to patients, first and foremost, and society as well as other health professionals and self. This chapter examines the ethical bases of the practices of medicine and the implications for anesthesiologists.
Guidelines for the Ethical Practice of Anesthesiology (AS1.3)
The Medical Council Act, 1956 incorporates ethics and regulations to govern the registered medical graduates in India. Therefore, qualified physicians must abide by regulations under the Indian Medical Council Act, especially Professional, Etiquette & Ethics Regulations, 2002, and subsequent amendments. The American Society of Anesthesiologists (ASA) has published a set of guidelines for anesthesiology’s ethical practice which was amended in 2020. The Indian Society of Anesthesiologists (ISA) has also emphasized the importance of ethics in anesthesia practice. Some basic principles within the medical ethics are discussed below.
Basic Principles of Medical Ethics (AS1.3)
Informed Written Consent
Obtaining consent by the treating physician for a given procedure from an individual in a sound mind is not just enough. It is the basic right of individuals to know the alternative treatments, steps, risks, and outcomes associated with the procedure they undergo. A good rapport and communication is an essential key to informed written consent.
Performing diagnostic tests on an individual is not without an ethical dimension. The intention of performing tests is to help the patient (beneficence) or use it to minimize other risks (nonmaleficence). However, medical tests may also carry implications for patients’ autonomy, privacy, and even social justice.
The anesthesiologist is responsible for patient positioning, and hence, we must be aware of various positions and their associated complications. The “captain of the ship” doctrine, which held the surgeon responsible for every aspect of the patient’s perioperative care, is no longer a valid notion when an anesthesiologist is present. The surgeon and anesthesiologist as a team are ultimately answerable to the patient rather than to each other.
Prospects of Anesthesiology as a Career (AS1.2, AS1.4)
An anesthesiologist is a well-trained specialist who works as a perioperative physician, makes anesthesia-related decisions, and is responsible for the patient’s safety and well-being inside the operation theater. Providing anesthesia involves putting the patient in a state of controlled unconsciousness for amnesia, providing pain relief, and monitoring critical life functions as they are affected throughout the surgical, obstetrical, and other medical procedures.
Choosing a specialty as a career choice is made either during medical school or during the internship. Several factors affect this choice: intrinsic (personal attributes) or extrinsic (local/medical/environmental effects). Among them, exposure to a subspecialty in the undergraduate/postgraduate curriculum may significantly affect the trainee’s career preferences.
Anesthesiology in the current era has evolved into a vast specialty not just limited to the operating room, with its subspecialties ranging from perioperative patient care, trauma care, obstetric and pediatric care to pain management and palliative care.
Various studies conducted to assess the awareness of anesthesiology’s scope as a career and subspecialty options stated that most students joining anesthesia training were unaware of it. Hence, the need to increase awareness both at the undergraduate and postgraduate levels is imperative. This has a vital implication in national workforce planning and future recruitment strategies for specialist doctors in our health care system. The various career opportunities in anesthesia are described below:
Career Path and Subspecialties
A cardiac surgical patient’s unique characteristics eventually led to cardiac anesthesiology’s development as a subspecialty. A cardiac anesthesiologist is a perioperative physician trained to manage cardiac patients undergoing various cardiothoracic surgeries and repair of congenital heart defects, heart transplantations, and implantation of mechanical assist devices. They also have expertise in vascular surgeries and serve as attending physicians in cardiothoracic intensive care units.