Chapter 89
- Ethical and Legal Aspects of Anesthesia Care
- David B. Waisel
- Robert D. Truog
Medical ethics is the discipline
that provides the tools necessary to recognize, analyze, and manage ethical dilemmas.
Medical ethics consists of obtaining factual clinical information, clarifying moral
dilemmas, and identifying alternative solutions to these ethical dilemmas. The law
is society's expression of the boundaries of ethically acceptable behavior. In the
United States, law consists of statute and case law. Statute
law is the body of prescriptive law and regulation created by the legislature.
When statute laws clash or when there is no definitive statute law, disagreements
may be adjudicated by the judicial system. Case law
is the aggregate of reported cases that form the body of jurisprudence, and the cases
can be used as bases for future court decisions. The results of these cases are
rarely prescriptive and may lead to a collection of confusing and even contradictory
cases that rest on different common law rulings and statutes in separate jurisdictions.
The law also provides sanctions to help enforce legislation.
For example, to improve emergency care, the government enacted the Emergency Medical
Treatment and Active Labor Act that required hospitals to provide emergency care
regardless of ability to pay and backed up this enforcement with penalties. However,
the power of sanctions may harm the aspirations of medical ethics, leading physicians
to resort to the least risky interpretation of the law.
It is said that the law defines what must be done, whereas medical
ethics seeks to define what ought to be done. Law provides the boundaries, and medical
ethics helps physicians navigate within boundaries, recognize when boundaries need
to be challenged, and make decisions in areas not governed by law, such as personal
behavior.
