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.

The ethical principle of respect for patient autonomy is firmly grounded in western ethical principles valuing individual freedoms. This chapter talks about autonomous choices, presenting a case of a 35-year-old man with colectomy. Of the four foundational principles in medical ethics: beneficence, nonmaleficence, respect for autonomy, and justice, the principle with the strongest influence in the United States is respect for personal autonomy. Three conditions must be met in order for an act (or choice) to be autonomous: a person must act with intention, with understanding, and without controlling influences. In the informed consent process, physicians have ethical obligations to avoid controlling influences that invalidate autonomous choice. Generally speaking intentional acts require planning, although not necessarily reflective thought or strategy. Coercion and manipulation are unethical because they violate the principle of respect for patient autonomy, and because manipulation often involves deception and violates physician obligations of veracity.

Torture is the deliberate infliction of mental and physical suffering in order to overcome resistance or to sufficiently disorient prisoners so that the torturer can intimidate, extract information, and obtain confessions. This chapter considers the morally impermissible nature of torture (as well as of coercive interrogation), the ethical prohibition of physician participation in torture, and the dilemma of dual loyalties facing physicians requested or mandated to participate in such universally condemned activities. Treaties and statements prohibiting torture encourage states not to torture so that their enemies also will not torture. However, some commentators suggest that torture should be a last resort only after other less intrusive measures have failed. Military physicians are faced with balancing what is simplistically known as "dual loyalty" when deciding whether they have an obligation to participate in coercive interrogation as part of their military and societal obligation.

Ethical principles of beneficence and nonmaleficence require that physicians strive to improve medical knowledge to improve patients' lives and avoid harmful or ineffective treatments. Publication serves critical processes in promoting the integrity and efficacy of the medical profession, and thereby in promoting patient wellbeing. Publication is a critical part of academic medicine, and sets scholarly work apart from the practice of medicine. Plagiarism violates ethical principles of nonmaleficence and justice. Authors have ethical obligations to be truthful regarding credit for the work and outcomes of research. Fabrication and falsification of data, plagiarism, misleading assignment of authorship and redundant publications all are detrimental to the mission of medical publication. Peer reviewers have obligations to be competent, fair, and balanced, and free of conflicts of interest in reviewing medical manuscripts. Journal editors have parallel responsibilities to assure accuracy in the medical literature.