Features  |   November 2017
Practical Ethics for the Anesthesiologist: Experiential ICU Teaching and Goals of Care
Author Affiliations
  • David L. Stahl, M.D.
    Committee on Critical Care Medicine
  • Shahla Siddiqui, M.B.B.S., DABA, FCCM, FAMS
    Committee on Critical Care Medicine
  • Nicholas Sadovnikoff, M.D., FCCM
    Committee on Critical Care Medicine
Article Information
Critical Care / Ethics / Medicolegal Issues / Features
Features   |   November 2017
Practical Ethics for the Anesthesiologist: Experiential ICU Teaching and Goals of Care
ASA Monitor 11 2017, Vol.81, 14-16.
ASA Monitor 11 2017, Vol.81, 14-16.
Anesthesiologists who practice critical care frequently face ethical dilemmas, particularly when caring for patients at the end of life. These ethical dilemmas, however, are not limited to intensivists. Anesthesiologists will also care for the nearly one-third of Medicare recipients who undergo surgery in the last year of their life.1  Most medical school curricula and residency competencies incorporate ethics teaching by means of didactic or case-based learning. Clinical ethics training incorporates the theories of ethical principles with added casuistic reflection.2  However, there remains a divide between this teaching and the real-life conundrums faced by physicians.3  Practical ethics teaching can be used to bridge this gap and personalize the process to make it more inclusive in overall patient management. We highlight two opportunities for the application of practical ethics in anesthesiology: experiential learning in the ICU during ethics rounds and the team-based preoperative goals of care setting. In ethics rounds, experienced intensive care doctors can share ethical or moral issues faced in the care of ICU patients with inter-professional input from other clinicians such as nurses and ethics consultants.4  In a team-based assessment of preoperative goals of care, anesthesiologists can apply their advanced training in perioperative medicine to ensure that the patient’s goals are met while planning for surgery.
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