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Advances in medical technology and transplantation lead to the re-defining of death to include death by virtue of brain death. The determination of whole brain death requires the demonstration of three things: an irreversible comatose state; the loss of brainstem reflexes; and brainstem inactivity leading to apnea. Protocols for the clinical determination of brain death vary among institutions but must generally be made by more than one doctor in one of several relevant specialties. Neurophysiologic determinations of cerebral circulatory arrest include four-vessel cerebral angiography as well as various scintigraphic perfusion studies. In all countries where brain death is recognized legally, the diagnosis rests with physical examination, at times supported by further medical testing. Philosophical arguments for the integrity of brain death as a definition of death rest in historic religious and social concepts of what constitutes life, or with ideas that loss of personhood may be equivalent to death.
Female genital cutting (FGC) has wide acceptance in many cultures across the globe despite gender-related and more general human rights concerns raised by the practice. This chapter presents a case study on a healthy 5-year-old female patient scheduled for surgical correction of clitoral phimosis. Physicians must understand the potential medical sequelae of FGC to make reasoned decisions about whether or not to participate in the procedure. Immediate adverse outcomes of FGC include pain, post-operative infection, shock, tetanus, hemorrhage, and death. Whether an anesthesiologist should participate in FGC depends on his or her interpretation of ethical considerations. Mostprofessional societies provide only guidance, without a binding effect on members.Physician participation in FGC may prevent some health consequences but also perpetuates objectionable social practices. Physicians' decisions to participate in FGC currently rely on personal judgments, weighing adverse medical and psychological consequences against potential cultural benefits and harms.
This chapter considers what it means to say that a being deserves moral consideration. It addresses the question what it means to say that a being has a right to life. The chapter explores the meaning of a right to life and considers the claim that, even if a being lacks a right to life, it deserves to have its interests taken into account. It considers three distinct answers: the conservative view, liberal view, and the moderate view to the issue of moral distinctiveness about humanity. Despite the fact that Immanuel Kant's philosophy encourages the humane treatment of animals, critics charge that it gives insufficient regard to animals. The chapter presents Peter Singer's seven ideas of argument against certain forms of animal experimentation. For Singer, the ethically crucial requirement is that our actions produce as much pleasure and happiness and as little pain and misery as possible for all beings.
Anesthesiologists should choose to involve children in medical decision-making with the ethical objective of enhancing the child's self-determination, while keeping the child engaged in their care. Anesthesiologists can use the patient's age as a first approximation of a patient's cognitive and emotional development. This chapter discusses the issues raised by incorporating the ethical concept of pediatric patient assent into the traditional process of parental (surrogate) informed consent. Competency is a legal term while decision-making capacity is the ability to make a specific decision at a specific time. It is important to resolve disagreements among the pediatric patient-parent-physician triad about the appropriate clinical plan. Response to requests for nondisclosure by parents must weigh the goal of the best Znterests of the patient. Emancipated minor and mature minor status pose distinct ethical and practical issues. Confidentiality must be honored, and failure to do so may be harmful to the patient.
A one-size-fits-all approach to pain management is not practical, nor ethically justifiable. This chapter explains pain management using the case study of a 61-year-old woman with metastatic colon cancer and intractable abdominal pain, as an example. Technological advancements within science and medicine have enabled prolongation of the lifespan for those patients with incurable diseases. Interventional techniques may be especially useful because of their capacity to effectively reduce pain, make patients more amenable to other therapeutics, and enhance patients' quality of life. Interventional pain management techniques and integrative pain medicine are underutilized, due to misperceptions by hospital operators and insurance companies about cost effectiveness. Employment of collaborative interventional techniques, however, has been shown to be both cost and time effective. Physicians should advocate policy development that is directed toward developing and enabling the profession and practice of pain/palliative care.
Chemical dependence in the form of addiction is a chronic relapsing disease characterized by the overwhelming compulsion to use drugs in spite of adverse consequences. The practice of anesthesiology provides the setting for a susceptible host by offering an environment in which powerfully addictive drugs are immediately available for abuse. Addictive disease in the form of chemical dependency is present in all classes, cultures, and professions including healthcare professionals. A major occupational hazard of anesthesiologists is the development of addictive disease, which, in the light of the specialty's powerful drugs, often involves a rapidly progressive, life- and career-threatening pattern of behavior. Anesthesiologists have an ethical responsibility to be knowledgeable about addiction, to detect it in its earliest stages, and to support the treatment, rehabilitation, and eventually, if appropriate, reentry into the workplace of a recovering colleague.
Ethical issues facing anesthesiologists are more far-reaching than those involving virtually any other medical specialty. In this clinical ethics textbook, authors from across the USA, Canada and Europe draw on ethical principles and practical knowledge to provide a realistic understanding of ethical anesthetic practice. The result is a compilation of expert opinion and international perspectives from clinical leaders in anesthesiology. Building on real-life, case-based problems, each chapter is clinically focused and addresses both practical and theoretical issues. Topics include general operating room care, pediatric and obstetrical patient care, the intensive care unit, pain practice, research and publication, as well as discussions of lethal injection, disclosure of errors, expert witness testimony, triage in disaster and conflicts of interest with industry. An important reference tool for any anesthesiologist, whether clinical or research-oriented, this book is especially valuable for physicians involved in teaching residents and students about the ethical aspects of anesthesia practice.