As someone who is deeply interested in medicine and the science that surrounds it, I have never been one to question its mechanisms. Due to my trust in the research, I view vaccinations, medications and anesthesia as strong components to care and healing. My fascination in medicine has caused me to pay attention to only the scientific side of the health care system. This has led me to form a very close-minded outlook, and it wasn’t until recently that I realized the extreme ethical implications that surround medicine – specifically anesthesia – and the healthcare system.
Anesthesia began in 1846 and had a very limited scope for a multitude of years. While anesthesia began in dentistry, throughout the years its technology has developed tremendously. The practice of anesthesia has expanded beyond surgery into management of all types of pain. Although anesthesia has been instrumental to medicine, it has been extremely controversial when it comes to its ethical implications. In the article “Ethical issues in anesthesia: the need for a more practical and contextual approach in teaching,” Seetharaman Hariharan – a professor of anesthesia and critical care medicine – discusses the preoperative, intraoperative, and postoperative ethical issues that surround the field. Hariharan touches on the basis that informed consent and bodily autonomy are critical concerns in anesthesia and that bringing awareness to this is essential for patient safety. The issue of consent has become an integral element in the debate of anesthesia. When anesthetized, patients lose bodily autonomy and are unable to consent to procedures and treatments – leaving them completely vulnerable and placing all trust on physicians and the healthcare team.
Many view anesthesia as a behind the scenes specialty, but anesthesiologists carry a huge role in patient safety and outcomes. The “Guidelines for the Ethical Practice of Anesthesiology” outline a body of ethics that members of the American Society of Anesthesiologists must follow – common themes of these guidelines concern the benefit of the patient and the improvement of the field. Still, even with such standards and heavy regulations, we see patients receiving medications and pelvic exams they did not consent to, as well as having individuals they did not approve of, or even meet, perform their surgery. These concerns are highlighted when we look at a 2005 survey conducted by the University of Oklahoma, which found that a majority of medical students had performed pelvic exams on unconscious patients, and in nearly three quarters of these instances they thought informed consent had not been obtained. This concern is not only one that can be applied to a particular medical school, hospital or personal identity. The issue extends beyond what we want to imagine, as patients continue to seek care every day in a system plagued with uncertainty.
Medical professionals continue to preach “do no harm” but if it’s not uncommon for such instances of unapproved treatment to happen, then why are we staying silent as future and current healthcare providers?
What Can You Do?
I didn’t know I wanted to be a physician until later than most, and while I saw flaws in the healthcare system from an early age, I was extremely unaware of how deep these issues go, and how far back they can be traced. Even as I got to college, I did not learn these things as a requirement for a major or path, which shows me that if you do not seek out this information, it is not something you will ever learn.
It is imperative that as future physicians we take the classes we are not required to take. Informing yourself about the deeply rooted social determinants of health and the history of medical practices is crucial towards understanding why our healthcare system is the way it is. We place such emphasis on the science behind medicine, but understanding these different external factors is nearly just as important as being a good physician.
One of the Guidelines for the Ethical Practice of Anesthesiology states that physicians should “also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.” Our generation carries a massive responsibility when it comes to the development of medicine. Immersing yourself into conversations on the ethics of the healthcare system is only the first step – we must be the ones that ask the difficult questions and inflict change within the system.