KEY POINTS
- Medical ethics consists of obtaining factual clinical information, clarifying
moral dilemmas, and identifying alternative solutions to these ethical dilemmas.
- The law provides the boundaries of acceptable behavior, 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.
- The goal of informed consent is to maximize the ability of the patient
to make substantially autonomous informed decisions.
- Anesthesiologists should permit pediatric patients and patients with uncertain
decision-making capacity to make decisions to the extent of their abilities.
- Competent patients have a virtually unlimited right to refuse life-sustaining
medical treatment.
- Before proceeding to the operating room, preoperative DNR orders should
be reevaluated in light of the surgical procedures, the anesthetic options, and the
patient's overall goals.
- Giving a patient a trial of therapy is an appropriate way to test whether
a therapy will be effective without committing the patient to undesirable, burdensome
care.
- Barriers to acceptance and implementation of perioperative DNR orders include
a physician's limited understanding of a patient's values, the closely linked environment
of the operating room, system problems, and the fear of being sued.
- A good death includes pain management, aggressive comfort care, maintenance
of dignity, a feeling of connectedness, and financial control.
- Conflict of interest has been defined as "a set of conditions in which
professional judgment concerning a primary interest (such as patient's welfare or
the validity of research) tends to be unduly influenced by a secondary interest."
[149]
Secondary interests may be financial, personal,
and professional, and they include gaining prestige, promotion, personal gratification,
and respect.
- Ethics committees and their consulting services act in an advisory role
to help caregivers, patients, and families amicably resolve ethical dilemmas.
- Professionalism is rooted in the obligations that arise from the implicit
social contract between society and the physician.
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