Biomedical ethics is an important topic within the realm of anesthesiology. Understanding each of the four principles of biomedical ethics can help ensure that all anesthesiologists take health-conscious, ethical measures daily.

Autonomy

Autonomy is the recognition that the individual patient has the right to self-determination. This means that the patient has the right to make decisions about healthcare procedures that affect their well-being and comfort. It runs counter to outdated practitioner-patient relationships, in which the practitioner took on a paternalistic role. In that relationship, it was assumed that the medical professional had the right to overrule the patient’s wishes – or worse, make decisions about the patient’s healthcare without first obtaining informed consent from the patient. It is in the realm of informed consent that autonomy is most prevalent as it relates to anesthesiology. Because of the risks associated with anesthesiology, it is critical to obtain specific informed consent – rather than assuming that consent to surgery implies consent to anesthesia.

Beneficence

Beneficence refers to the duty of the healthcare practitioner to promote the health, comfort and well-being of their patients. This can often be a difficult principle to apply, as the right diagnosis for obtaining the most favorable outcome can be hard to assess. This is particularly true when risk factors potentially outweigh the beneficial outcomes a procedure or therapy may produce. As it applies to anesthesiology, beneficence is best considered in terms of preventing complications for the patient. This requires anesthesiologists to always consider the risks and potential benefits of any actions they take on behalf of the patient to ensure they are always providing the most beneficial outcome in a given situation.

Nonmaleficence

The practitioner’s primary task is to do no harm to the patient, which means that it is more important not to harm the patient than it is to help them. Without understanding the applications of the principle of nonmaleficence in practice management, the overeager practitioner will often do harm when they apply a treatment they erroneously believe will do good. This principle is incredibly important and has obvious applications to the anesthesiologist. Anesthesia can be quite risky to the patient, and in the interest of reducing pain and improving comfort, it is all too easy to do harm to them by applying incorrect doses or combinations of anesthesia. It is imperative to always keep the principle of nonmaleficence in one’s mind when treating a patient, and especially so for the anesthesiologist.

Justice

Justice requires the practitioner to act fairly at all levels of care, from individuals, to groups, to communities. The practitioner must fairly distribute resources and services among individuals and throughout communities, and it also requires the practitioner to consider the long-term effects their actions will have on a patient. Justice can be one of the most difficult principles of biomedical ethics to apply. For the anesthesiologist, it means not only applying fairness when treating individual patients, but also providing leadership in situations where they witness injustice on the part of other healthcare practitioners.

The proper application of these principles to practice management is a challenging goal to meet, and one that requires leadership at all levels. The anesthesiologist’s approach for making good ethical decisions requires them to assess each action they take in terms of the principles. First: are they doing no harm? Second: are they respecting the patient’s autonomy and providing informed consent? Third: are their actions benefiting the patient? And fourth: are they taking action justly, and leading others by example and – when necessary – intervening in unjust actions on the part of others? Every patient interaction should be guided by this series of questions, not only at the beginning but throughout and with a view to the patient’s long-term care and quality of life.

Sources:

http://jme.bmj.com/content/30/3/286.full

http://www.scielo.br/scielo.php?pid=S0034-70942006000300011&script=sci_arttext&tlng=en

http://www.medscape.com/viewarticle/811079_5

http://ispub.com/IJA/9/1/12209

http://ispub.com/IJA/9/1/12209

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abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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