Guidelines for the Ethical Practice of Anesthesiology

Developed By: Committee on Ethics
Last Amended: December 13, 2020 (original approval: October 15, 2003)

PREAMBLE

Membership in the American Society of Anesthesiologists is a privilege of physicians who are dedicated to the ethical provision of health care. The Society recognizes the Principles of Medical Ethics of the American Medical Association (AMA) as the basic guide to the ethical conduct of its members.

AMA Principles of Medical Ethics (2001)

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals and to self. The following Principles adopted by the American Medical Association are not laws but standards of conduct which define the essentials of honorable behavior for the physician.

1. A physician shall be dedicated to providing competent medical care with compassion and respect for human dignity and rights.
2. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception to appropriate entities.
3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
4. A physician shall respect the rights of patients, colleagues and other health professionals and shall safeguard patient confidences and privacy within the constraints of the law.
5. A physician shall continue to study, apply and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A physician shall, in the provision of appropriate patient care except in emergencies, be free to choose whom to serve, with whom to associate and the environment in which to provide medical care.
7. A physician shall recognize a responsibility to participate in activities contributing to improvement of the community and betterment of public health.
8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
9. A physician shall support access to medical care for all people.

The practice of anesthesiology involves special problems relating to the quality and standards of patient care. Therefore, the Society requires its members to adhere to the AMA Principles of Medical Ethics and any other specific ethical guidelines adopted by this Society.

ASA ETHICAL GUIDELINE

There may be specific circumstances when elements of the following guidelines may not apply and wherein individualized decisions may be appropriate.

I.    Anesthesiologists have ethical responsibilities to their patients.

1. The patient-physician relationship involves special obligations for the physician that include personal interaction with the patient, placing the patient’s interests foremost, faithfully caring for the patient and being truthful. 
2. Anesthesiologists respect the right of every patient to self-determination. Anesthesiologists should include patients, including minors, in medical decision-making that is appropriate to their developmental capacity and the medical issues involved. Anesthesiologists should not use their medical skills to restrain or coerce patients who have adequate decision-making capacity.
3. Anesthetized patients are particularly vulnerable, and anesthesiologists should strive to care for each patient’s physical and psychological safety, comfort and dignity. Anesthesiologists should monitor themselves and their colleagues to protect the anesthetized patient from any disrespectful or abusive behavior.
4. Anesthesiologists should keep confidential patients’ medical and personal information.
5. Anesthesiologists should provide preanesthetic evaluation and care and should personally provide or participate in the process of informed decision-making, especially regarding the choice of anesthetic technique.
6. Anesthesiologists should inform the patient if other physicians, physicians-in-training, or nonphysician providers are likely to participate in the patient’s anesthesia care.
7. Anesthesiologists should be honest and forthcoming when describing their level of patient care involvement to their patient, the patient’s family or surrogate, to hospitals, and the community. A description of such is an essential element of informed consent.
8. When working with nonphysician anesthesia providers or physicians-in-training in the provision of anesthesia care, anesthesiologists should remain personally and continuously available during the anesthetic; they should be able to directly participate in the most demanding aspects of the anesthetic care.
9. Anesthesiologists should provide for appropriate postanesthetic care for their patients.
10. Anesthesiologists should not participate in exploitive financial relationships.
11. Anesthesiologists share with all physicians the responsibility to provide care for patients irrespective of their ability to pay for their care. Anesthesiologists should provide such care with the same diligence and skill as for patients who do pay for their care.

II.   Anesthesiologists have ethical responsibilities to medical colleagues.

1. Anesthesiologists should promote a cooperative and respectful relationship with their professional colleagues that facilitates quality medical care for patients. This responsibility respects the efforts and duties of other care providers including physicians, medical students, nurses, technicians and assistants.
2. Anesthesiologists should provide timely medical consultation when requested and should seek consultation when appropriate.
3. Anesthesiologists should cooperate with colleagues to improve the quality, effectiveness and efficiency of medical care.
4. Anesthesiologists should advise colleagues whose ability to practice medicine becomes temporarily or permanently impaired to appropriately modify or discontinue their practice. They should assist, to the extent of their own abilities, with the re-education or rehabilitation of a colleague who is returning to practice.
5. Anesthesiologists should not take financial advantage of other physicians, nonphysician anesthesia providers or staff members. Verbal and written contracts should be honest and understandable, and should be respected.

III.  Anesthesiologists have ethical responsibilities to the health care facilities in which they practice.

1. Anesthesiologists should serve on health care facility or specialty committees. This responsibility includes making good faith efforts to review the practice of colleagues and to help develop departmental or health care facility procedural guidelines for the benefit of the health care facility and all of its patients.
2. Anesthesiologists share with all medical staff members the responsibility to observe and report to appropriate authorities any potentially negligent practices or conditions which may present a hazard to patients or health care facility personnel.
3. Anesthesiologists personally handle many controlled and potentially dangerous substances and, therefore, have a special responsibility to keep these substances secure from illicit use. Anesthesiologists should work within their health care facility to develop and maintain an adequate monitoring system for controlled substances.

IV.  Anesthesiologists have ethical responsibilities to themselves.

1. The achievement and maintenance of competence and skill in the specialty is the primary professional duty of all anesthesiologists. This responsibility does not end with completion of residency training or certification by the American Board of Anesthesiology.
2. The practice of quality anesthesia care requires that anesthesiologists maintain their physical and mental health and special sensory capabilities. If in doubt about their health, then anesthesiologists should seek medical evaluation and care. During this period of evaluation or treatment, anesthesiologists should modify or cease their practice.

V.   Anesthesiologists have ethical responsibilities to their community and to society.

1. An anesthesiologist shall recognize a responsibility to participate in activities contributing to an improved community.
2. An anesthesiologist who serves as an expert witness in a judicial proceeding shall possess the qualifications and offer testimony in conformance with the ASA “Guidelines for Expert Witness Qualifications and Testimony.”
3. An anesthesiologist shall not engage in misconduct in research and/or publication.
4. An anesthesiologist should take into account the environmental impact of their clinical management and decision making