Professional Practice and Ethics
Core concepts
Ethics in anesthesia centers on informed consent, capacity, confidentiality, truthfulness, and advocacy. Informed consent requires disclosure of risks, benefits, alternatives, and the right to refuse. Capacity is decision-specific: can the patient understand, appreciate, reason, and communicate a choice? When capacity is absent, follow advance directives and surrogate decision-makers.
Know the difference between ethical principles: autonomy (patient choice), beneficence (do good), nonmaleficence (avoid harm), justice (fairness), and veracity. Understand do-not-resuscitate orders and how they apply in the perioperative period; they are not automatically suspended and should be reviewed with the patient or surrogate.
Professionalism includes scope of practice, documentation, avoiding conflicts of interest, and honest reporting of complications. Recognize impaired colleagues and mandatory reporting obligations, and understand that patient safety may justify limited breach of confidentiality.
Traps
- Equating refusal of treatment with incapacity.
- Assuming a DNR order is automatically void in the operating room.
- Confusing confidentiality with absolute secrecy when safety is at risk.
- Ignoring surrogate hierarchy when the patient lacks capacity.
Rule of thumb
Respect autonomy first; if capacity is unclear, assess it formally and involve the surrogate. Document discussions. When safety and confidentiality conflict, disclose only what is necessary.
Worked example
A competent adult refuses a recommended blood transfusion before elective surgery. After confirming understanding of risks and alternatives, the anesthesiologist respects the refusal, documents the discussion, and plans blood-conservation strategies rather than proceeding against the patient's wishes.