The issue of treating friends and family members is a fraught subject for physicians. But the question of administering anesthesia to close relatives can be particularly complicated from an ethical standpoint, and guidance on whether you should or shouldn’t isn’t always clear.
“Ethical principles are widely supported, but the applications are ambiguous,” explains Robert Johnstone, MD, professor and chair of the department of anesthesiology at West Virginia University. “The ethical principles are situational and can change over time.”
In his lecture “Is It Ethical to Anesthetize a Close Relative?” available now for CME credit through AudioDigest, Dr. Johnstone outlines guidance issued by the American Medical Association (AMA) and adopted by the American Society of Anesthesiologists. He also shares several experiences where he anesthetized family members throughout his career, bringing a real-world perspective to one of the most perplexing types of doctors’ ethical dilemmas.
American Medical Association Guidance
In 2012, according to Johnstone, the AMA published ethical guidance around whether a physician should treat close family members, including whether they should provide anesthesia. The gist is that physicians shouldn’t do so for a variety of reasons.
For example, rendering care to a loved one could cloud a physician’s professional judgment, or it might make it difficult to ask sensitive — but pertinent — health-related questions. In such cases, it’s also possible you could be motivated to provide treatment outside your scope of expertise, potentially leading to anger or hurt feelings over adverse outcomes.
But this is where the ethical dilemma gets sticky, Johnstone explains. The AMA guidance doesn’t strictly forbid anesthetizing close relatives. In certain situations, like emergencies, it could be necessary.
Just as guidance from leadership organizations is scant and vague on providing care of any kind, including anesthesia, so is the body of literature, Johnstone notes. In fact, he was only able to find two publications — from the Western Journal of Medicine and the New England Journal of Medicine — that address the issue, and none spoke specifically to administering anesthesia.
The spring 2018 issue of Narrative Inquiry in Bioethics did tackle the dilemma physicians can face when they’re asked to provide care for family members. According to the doctors in the issue, it can be difficult to separate your professional self from your personal self. The internal struggle to approach the situation as a physician while grappling with worry, fear or other emotions can present difficulties for providers who opt to be involved in a loved one’s care.
A Hastings Center article on the issue further outlined the feelings shared by providers: “They were unable to be objective, tolerate a loved one’s pain, or keep medical decisions separate from family dynamics. At the same time, each of the authors was in possession of knowledge, opinions, and connections that could help their loved one facing a health crisis, and withholding these resources may have seemed impossible.”
Still, Johnstone says, the recommendations and assessments provided in the literature were generalized and offered no real-world perspectives concerning anesthesia.
Overall, Johnstone suggests that most ethical situations around administering anesthesia will likely best be handled on a case-by-case basis. He shares several personal examples when he administered anesthesia to close family members, illustrating in what instances doing so might be necessary.
He discusses two incidents when he performed an epidural during his wife’s pregnancies — one planned and one emergency. In addition, he shares the circumstances around which he provided anesthesia to one daughter for oral surgery and to another during labor and delivery.
Ultimately, he says, any decision around administering anesthesia to close relatives should be weighed carefully. “As doctors, we have a duty to do good without doing any harm. And, as families, we are taught to take care of each other.”