The Anlet: anesthesiology's response to the needs of the Armed Forces in World War II.
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Anesthesiology↗
Biomedical subjects
David Waisel
Publications and source records attributed to David Waisel.
Informed consent: ethical implications in clinical practice.
PURPOSE OF REVIEW: The concept of involving pediatric patients in medical decision-making, in both clinical and research anesthesia and surgical care, has support from specialists involved in pediatric care. Production pressure in the workplace creates conflict between ethical anesthesia practice - such as obtaining informed consent - and time efficiency. Specialized documentation of anesthesia consent may increase efficiency but could weaken the consent process. Concerns with cost containment have led to interventional quality improvement activities that may constitute research and therein require informed consent. This review discusses these three consent issues as they relate to anesthesia care. RECENT FINDINGS: Children are more capable of participating in medical decision-making than previously thought. Despite the call for physicians to involve children in decision-making regarding their medical care, few physicians or parents do so. Quality improvement research potentially harmful to patients, achieved without patient knowledge or consent, may violate the Nuremberg Code. Opinions differ about the potential advantages and pitfalls of specific and separate anesthesia consent forms. SUMMARY: Anesthesiologists have ethical obligations to involve children in the medical decision-making process as much as the child's capacity allows, and to place patient advocacy in the informed consent process above production pressures. While a specific and separate anesthesia informed consent form may be useful, it should not undermine the process of informed consent or relegate the consent process to non-physician personnel. The informed consent process for anesthesia care remains the province and responsibility of the individual anesthesiologist.
Journal Article↗
Should do-not-resuscitate orders be suspended for surgical cases?
PURPOSE OF REVIEW: There are significant misunderstandings about the management of perioperative do-not-resuscitate orders. This paper reviews some of the difficulties generated by the halting acceptance and inconsistent implementation of an ethically appropriate perioperative do-not-resuscitate policy that mandates reconsideration of existing do-not-resuscitate orders. It also offers strategies for empowerment of such a policy. RECENT FINDINGS: Recent advances in the ethical practice of anesthesiology have centered on determining and correcting why perioperative do-not-resuscitate policies are poorly accepted, and how to establish a hospital-wide adherence to such policies. Barriers to ethically appropriate application of perioperative do-not-resuscitate orders include differing values and misunderstandings between physicians and their patients - and also between anesthesiologists and other physicians - as well as medicolegal concerns. Policies should be designed and implemented at the level of the healthcare institution, and they must be sufficiently flexible to permit the tailoring of the perioperative do-not-resuscitate order to the autonomous choice of the patient. Such policies should state unambiguously that existing do-not-resuscitate orders are to be reevaluated, delineate responsibilities for reconsidering the do-not-resuscitate order, state available options, define necessary documentation, and list resources for help. SUMMARY: A well written perioperative do-not-resuscitate policy is essential for surmounting obstacles to a well functioning perioperative do-not-resuscitate system.
Journal Article↗