Best practice & research. Clinical anaesthesiology
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Public expectations of healthcare have changed dramatically over the last 10-20 years, particularly in relation to the involvement of patients in determining treatment options and the selection of the most appropriate treatment plan. Paternalistic actions of doctors, which involved telling the patient what treatment they were going to receive, without discussing risks and benefits of various options, are no longer acceptable. This has been reflected in decisions reached by the courts in cases in which patients have entered litigation on the basis that inadequate information was given to them before treatment, and that they were unaware of risks of complications which subsequently materialised. ⋯ Complaints about lack of information or inadequate consent can also result in a doctor being reported to regulatory authorities. It is therefore necessary for anaesthetists to be aware of current issues surrounding provision of information and obtaining consent for anaesthesia in various categories of patient. This article summarises these issues.
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Society and the culture of health care delivery have radically changed over the last thirty years, the rate of change increasing exponentially towards the present time. Maternity care has been part of that change. Previously paternalistic obstetricians told women whether they should or should not become pregnant, advised hospital confinements, kept women in hospital for days after their confinements, and discussed little of their management with the women themselves. ⋯ This was, and to a certain extent still is, threatening to obstetricians. But there are also genuine concerns as to whether these changes will adversely influence the morbidity and mortality of mother and child. This chapter deals with issues of maternal choice from pre conception through to the post natal period, looking at how the exercise of maternal choice may conflict with the advice of the medical profession, potentially leaving accountability and responsibility a very grey area and how all this impinges on the anaesthetist.
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This chapter discusses a framework for and process of ethical decision making in the context of the discipline, theories, and principles of ethics. Daily decision making within the Hospital Ethics Committee is considered and some of the emerging ethical issues in anaesthesia are discussed.
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Intensive Care Medicine epitomises the difficulties inherent in modern medicine. In this chapter we examine some key medicolegal and ethical areas that are evolving. The principles of autonomy and consent are well established, but developments in UK caselaw have shown that the courts may be moving away from their traditional deference of the medical profession. We examine some recent cases and discuss the impact that these cases may have on practice in Intensive Care.
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The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. ⋯ Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.