Do the Right Thing: Resolving Ethical Dilemmas in the OR

Abstract

Although there have been ethical debates in medicine for centuries, only in the last few decades has bioethics, a term first coined in the 1970s, developed into a formalized and independent field of philosophy. Today, the influence of bioethics is far-reaching, impacting the drafting of laws pertaining to medicine and biotechnology, guiding the development of hospital policies and procedures, and even affecting the physician–patient relationship. Education about bioethics is incorporated into the curriculum for nurses, doctors, and other practitioners, and knowledge of the topic is assessed in many licensing and board certification examinations, including that of the American Board of Anesthesiology. Like bioethics, anesthesiology is also a relatively young field that has experienced tremendous growth in the modern era, and its history is marked by several prominent ethical debates. At one time, the use of anesthesia itself was quite controversial. Within months of William Morton’s successful demonstration of ether anesthesia on October 16, 1846, physicians around the world were utilizing this new discovery on countless surgical patients. Although the advent of painless surgery was met with widespread enthusiasm, it was also recognized almost immediately as a potentially dangerous new technology. Reports of anesthesia-related injuries and deaths were almost immediate and led many to recommend only its most cautious and judicious use. Surgeons at the Pennsylvania Hospital in Philadelphia went so far as to prohibit anesthesia altogether for a full 7 years after its introduction. The ethical debate of whether to utilize anesthesia was not simply limited to issues of safety, however. Many 19th century physicians subscribed to the philosophy of ‘‘natural healing’’ and the belief that pain and sickness arose from behavior that violated the laws of Nature. If anesthesia masked such pain, the patient would not rectify his or her behavior, and the illness would persist (Supplemental Digital Content 1, http://links.lww.com/ASA/A573).