Edited by Gail A. Van Norman, M.D., Stephen Jackson, M.D., Stanley H. Rosenbaum, M.A., M.D., and Susan K. Palmer, M.D. New York, Cambridge University Press, 2011. Pages: 318. Price: $66.00.
When one thinks of the ethical issues in the care of patients today, the issues specific to anesthesiology may not immediately rise to the top of the list. Nevertheless, Clinical Ethics in Anesthesiology: A Case-based Textbook is an important book that deserves a place on the shelf of both practicing anesthesiologists and those with a scholarly interest in ethics. This is a multi-authored text edited by four well-respected anesthesiologists.
The book is divided into six sections that address both important topics for medical ethics (considered broadly) and specific topics of particular relevance to the specialty of anesthesiology: consent and refusal; end-of-life issues; pain management; research and publication; practice issues; and anesthesiologists, the state, and society. Each chapter begins with a specific case that focuses the issue squarely in the context of anesthesiology. The chapters are well-organized, with helpful subheadings of important concepts as well as a table of “key points” at the end of every chapter and a series of references for further reading.
Although one might initially question the need for another text devoted to the ethical issues of a particular specialty, I believe this book fills an important niche. No one would argue that the issues raised in the book are unique to anesthesiologists alone. However, I would argue that a volume such as this is critical for anesthesiologists to understand the ethical implications of some of these topics for their specialty. For example, although it might not be evident to all why the topic “informed consent for preoperative testing” should be included in such a text, Van Norman clearly makes the case in her chapter on this subject that this is a central issue for an anesthesiologist to consider. In the case provided, a 15-yr-old girl is about to undergo an elective diagnostic arthroscopy for pain and swelling. The patient, accompanied by her mother, denies being sexually active. However, the anesthesiology group that covers this hospital requires pregnancy testing before elective surgery in female patients. Once the pregnancy test comes back positive, the anesthesiologist is faced with a series of difficult issues. For example, state law forbids disclosing that information to anyone other than the patient, but the mother will likely suspect the finding if the case is canceled. In addition, state law requires reporting this finding to Child Protective Services as evidence of sex with a minor. Van Norman thoughtfully considers these topics along with others, such as assessing the evidence to support any routine preoperative testing.
This is just one example of the manner in which the authors of the chapters are able to bring important ethical considerations into case contexts that are familiar to anesthesiologists. There is ample suggestion in the text that ethical decisions in anesthesiology cannot and should not be made in isolation from other medical and surgical disciplines. However, the overarching theme is that the anesthesiologist must also be aware of, and integrally involved in, the ethical decision-making around many important clinical topics.
Although scholars of clinical medical ethics will not find new and groundbreaking information in this text, it is nevertheless an important book for this group as well. In order to make the case that ethical discussion is important for all medical disciplines, there must be examples that resonate with many different practitioners. As a surgeon, I see significant overlap between the ethical issues in anesthesiology and in surgery, yet when I present ethics cases to residents and fellows, I invariably focus on the ethical issues for the surgeon. The focus and perspective taken on any topic in ethics will alter the extent to which a particular specialist might see the case and the topic as relevant.
Although there is room for discussion and disagreement about how truly distinct the ethics of anesthesiology should be from, for example, the ethics of surgery, there should be no disagreement over the importance of addressing ethical issues from the perspective of specific disciplines. Such focused considerations make clear that the field of clinical medical ethics requires attention from all specialties in medical practice.