Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are (...) “captain of the ship” in the operating theater (leaving anesthesiologists in a subservient role. We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon’s preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia. (shrink)

Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are (...) “captain of the ship” in the operating theater (leaving anesthesiologists in a subservient role).We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon’s preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia. (shrink)

La formación profesional tiene un carácter contextualizado que responde a las exigencias que la época, la sociedad y el país reclaman a las universidades. La Estomatología en Cuba no se encuentra al margen de estos preceptos por lo que desarrolla un plan de estudio que acentúa la flexibilidad para realizar modificaciones necesarias y pertinentes. El estudiante al culminar la carrera debe brindar una atención estomatológica integral donde las anomalías dentomaxilofaciales constituyen la tercera línea de trabajo. Estas ocasionan afectaciones estéticas que (...) repercuten en la autoestima y adaptación social de niños y adolescentes por lo que se necesita de una orientación sicoeducativa, acción para la cual el profesional deberá estar preparado. A partir de las insuficiencias detectadas en el proceso formativo del estomatólogo, el objetivo del presente trabajo es proponer un curso propio sobre la temática para favorecer la graduación de un profesional capaz de resolver los problemas que afectan el complejo estomatognático con un enfoque biosicosocial. Los métodos empleados fueron el histórico-lógico y análisis-síntesis. Professional training has a contextualized nature which reflects the demands that the time, society and the country require from universities. In Cuba, Stomatology is not out of these precepts and therefore it carries out a syllabus that emphasizes flexibility to make necessary and appropriate changes. When students graduate, they must provide a complete stomatological care where dental maxillofacial anomalies are the third line of work. They cause aesthetic harm that affects children and teenagers' self-esteem and social adaptation which makes psych educational guidance necessary; a situation professional must be prepared for. Starting from the weak points discovered in the training process of stomatologists, a crash course in the subject is suggested in order to favor the graduation of professionals who are able to solve problems that affect the stomatognatic complex with a biopsychosocial approach, through the use of required methods, techniques and procedures. (shrink)

RESUMEN Introducción: No todos los especialistas en formación en Anestesiología y Reanimación revelan una actuación eficiente en la atención al paciente en shock. Objetivo: Exponer elementos relacionados con un sistema de talleres docentes para potenciar la preparación del especialista en formación en Anestesiología para la atención médica integral al paciente en shock. Material y método: Se realizó un estudio prospectivo con enfoque cualitativo que tiene en cuenta la sistematización de los referentes teóricos esenciales que posibilitan la satisfacción del objetivo declarado. (...) Resultados: se definió operacionalmente la categoría preparación del especialista en formación en Anestesiología y Reanimación para la atención médica integral al paciente en shock, y se diseñó un sistema de talleres docentes que puede guiar el trabajo metodológico del colectivo de profesores para la consecución de este propósito. Discusión: Se propuso una modelación didáctica del proceso de preparación de este especialista en formación, que puede tributar a una transformación cualitativamente superior del proceso de formación, y a la profesionalización pedagógica del docente. ABSTRACT Introduction: Not all the specialists in formation in Anesthesiology and Revival reveal an efficient performance in the attention to the patient in shock. Objective: To exhibit elements related to a system of teaching workshops to promote the preparation of the specialist in formation in Anesthesiology for the integral medical attention to the patient in shock. Material and method: A pilot study was carried out with qualitative approach that bears in mind the systematization of the essential theoretical basis that make possible the satisfaction of the declared objective. Results: it was defined operationally the category preparation of the specialist in formation in Anesthesiology and Revival for the integral medical attention to the patient in shock, and it was designed a system of teaching workshops that can guide the methodological work of the teachers' group for the attainment of this intention. Discussion: There was proposed a didactic modeling of the process of preparation of this specialist in formation, which it can contribute to a qualitatively top transformation of the process of formation, and to the pedagogic professionalization of the teacher. (shrink)

Once anesthetized, patients are inherently “compliant” with surgical interventions because they can no longer intervene on their own behalf. In their target article, Minkoff et al. (2024) reasonabl...

RESUMEN El presente trabajo de revisión expone cómo las prácticas de gestión en la anestesiología deben ser modificadas para encarar las cambiantes necesidades de pacientes, otros profesionales y sistemas sanitarios, a fin de mantener una función significativa en la atención sanitaria. Los servicios de anestesia han adoptado una amplia variedad de modelos para hacer frente a las necesidades del medio local, la relación entre los anestesiólogos y la comunidad, y los papeles desempeñados por los anestesiólogos en el tratamiento perioperatorio. El (...) sistema sanitario cubano se encuentra inmerso en un proceso de permanente adecuación de sus servicios a los problemas, demandas y necesidades de la población cubana y sus determinantes. Por ello, objetivo es exponer consideraciones teóricas en función del perfeccionamiento del servicio de Anestesiología y Reanimación. ABSTRACT This review paper presents how anesthesiology management practices must be modified in order to deal with the changing needs patients, other professionals and health systems have, in order to maintain a significant function in health care. Anesthesiology services have adopted a wide variety of models to face up to the needs the city, the relationship between anesthesiologists and the community and the role anesthesiologists play in perioperative treatment have. The Cuban health system services are in a process of permanent adaptation to the problems, demands and needs the Cuban population and its determinants have. For that reason, this paper aims at presenting theoretical considerations towards the improvement of the Anesthesiology and Resuscitation service. (shrink)

The global emergency caused by the spread of COVID-19 raises critical challenges for individuals and communities on many different levels. In particular, politicians, scientists, physicians, and other professionals may face new ethical dilemmas and cognitive constraints as they make critical decisions in extraordinary circumstances. Philosophers and cognitive scientists have long analyzed and discussed such issues. An example is the debate on moral decision making in imaginary scenarios, such as the famous “Trolley Problem”. Similarly, dramatic and consequential decisions are realized daily (...) in the current crisis. Focusing on Italy, we discuss the clinical ethical guidelines proposed by the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, highlighting some crucial ethical and cognitive concerns surrounding emergency decision making in the current situation. (shrink)

This book brings together ancient spiritual wisdom and modern science and philosophy to address age-old questions regarding our existence, free will and the nature of conscious awareness. Stuart Hameroff MD Professor, Anesthesiology and Psychology, and Director, Center for Consciousness Studies The University of Arizona, Tucson, Arizona This book presents a rich, broad-ranging overview of contemporary research and scholarship into consciousness and the self.... It is... to their credit that the editors have assembled a highly stimulating set of scholars whose (...) expertise cover all the relevant areas. I strongly recommend the book to anyone with an interest in understanding the directions in which contemporary thinking about the nature of consciousness is headed. B. Les Lancaster Emeritus Professor of Transpersonal Psychology Liverpool John Moores University, UK This volume is a collection of 17 essays that contribute to the emerging discipline of consciousness studies with particular focus on the concept of the self. The essays together argue that to understand consciousness is to understand the self that beholds consciousness. Two broad issues are addressed in the volume: the place of the self in the lives of humans and nonhuman primates; and the interrelations between the self and consciousness, which contribute to the understanding of cognitive functions, awareness, free will, nature of reality, and the complex experiential and behavioural attributes of consciousness. The book presents cutting-edge and original work from well-known authors and scholars of philosophy, psychiatry, behavioural sciences and physics. This is a pioneering attempt to present to the reader multiple ways of conceptualizing and thus understanding the relation between consciousness and self in a nuanced manner. (shrink)

Today we’re talking with Stuart Hameroff, Professor Emeritus at the Departments of Anesthesiology and Psychology, and Director of the Center for Consciousness Studies, at the University of Arizona. Dr Hameroff is best-known for his research on 'quantum consciousness', an alternative model to the accepted view of how consciousness arises. With Sir Roger Penrose, Dr Hameroff has proposed that consciousness arises at the quantum level within structures inside neurons, known as microtubules.

In this commentaryI evaluate the claim made byKeenan, Nelson, OÕConnor, and Pascual-Leone (2001) that since self-recognition results from right hemispheric activity, self-awareness too is likely to be produced by the activity of the same hemisphere. This reasoning is based on the assumption that self-recognition represents a valid operationalization of self-awareness; I present two views that challenge this rationale. Keenan et al. also support their claim with published evidence relating brain activityand self-awareness; I closelyexamine their analysis of one specific review of (...) literature and conclude that it appears to be biased. Finally, recent research suggests that inner speech (which is associated with left hemispheric activity) is linked to self-awareness—an observation that further casts doubt on the existence of a right hemispheric self-awareness. Ó 2002 Elsevier Science (USA). All rights reserved. (shrink)

Five decades ago, Henry Knowles Beecher, a renowned professor of research anesthesiology, sought to solve a problem created by modern medicine. The solution proposed by Beecher and his colleagues on the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proved very influential.1 Indeed, other contemporaneous medical developments magnified its significance yet also made the solution it offered somewhat problematic. As we mark this fiftieth anniversary, at a time when concerns about the conceptual (...) model on which its recommendations rested are being voiced by critics from medicine as well as philosophy, it is worthwhile to view the committee's report in relation to the problem that prompted its existence as well as the one to which it was quickly applied. (shrink)

The potential anesthetic neurotoxicity on the neonate is an important focus of research investigation in the field of pediatric anesthesiology. It is essential to understand how these anesthetics may affect the development and growth of neonatal immature and vulnerable brains. Functional magnetic resonance imaging has suggested that using anesthetics result in reduced functional connectivity may consider as core sequence for the neurotoxicity and neurodegenerative changes in the developed brain. Anesthetics either directly impact the primary structures and functions of the (...) brain or indirectly alter the hemodynamic parameters that contribute to cerebral blood flow in neonatal patients. We hypothesis that anesthetic agents may either decrease the brain functional connectivity in neonatal patients or animals, which was observed by fMRI. This review will summarize the effect and mechanism of anesthesia on the rapid growth and development infant and neonate brain with fMRI through functional connectivity. It is possible to provide the new mechanism of neuronal injury induced by anesthetics and objective imaging evidence in animal developing brain. (shrink)

RESUMEN El presente trabajo de revisión expone cómo las prácticas de gestión en la anestesiología deben ser modificadas para encarar las cambiantes necesidades de pacientes, otros profesionales y sistemas sanitarios, a fin de mantener una función significativa en la atención sanitaria. Los servicios de anestesia han adoptado una amplia variedad de modelos para hacer frente a las necesidades del medio local, la relación entre los anestesiólogos y la comunidad, y los papeles desempeñados por los anestesiólogos en el tratamiento perioperatorio. El (...) sistema sanitario cubano se encuentra inmerso en un proceso de permanente adecuación de sus servicios a los problemas, demandas y necesidades de la población cubana y sus determinantes. Por ello, objetivo es exponer consideraciones teóricas en función del perfeccionamiento del servicio de Anestesiología y Reanimación. ABSTRACT This review paper presents how anesthesiology management practices must be modified in order to deal with the changing needs patients, other professionals and health systems have, in order to maintain a significant function in health care. Anesthesiology services have adopted a wide variety of models to face up to the needs the city, the relationship between anesthesiologists and the community and the role anesthesiologists play in perioperative treatment have. The Cuban health system services are in a process of permanent adaptation to the problems, demands and needs the Cuban population and its determinants have. For that reason, this paper aims at presenting theoretical considerations towards the improvement of the Anesthesiology and Resuscitation service. (shrink)

feelings (brainstem, limbic system). The best scientific synchrony and consciousness.21,27 Anesthesiology, V 105, No 2, Aug 2006.

RESUMEN El presente trabajo de revisión expone cómo las prácticas de gestión en la anestesiología deben ser modificadas para encarar las cambiantes necesidades de pacientes, otros profesionales y sistemas sanitarios, a fin de mantener una función significativa en la atención sanitaria. Los servicios de anestesia han adoptado una amplia variedad de modelos para hacer frente a las necesidades del medio local, la relación entre los anestesiólogos y la comunidad, y los papeles desempeñados por los anestesiólogos en el tratamiento perioperatorio. El (...) sistema sanitario cubano se encuentra inmerso en un proceso de permanente adecuación de sus servicios a los problemas, demandas y necesidades de la población cubana y sus determinantes. Por ello, objetivo es exponer consideraciones teóricas en función del perfeccionamiento del servicio de Anestesiología y Reanimación. ABSTRACT This review paper presents how anesthesiology management practices must be modified in order to deal with the changing needs patients, other professionals and health systems have, in order to maintain a significant function in health care. Anesthesiology services have adopted a wide variety of models to face up to the needs the city, the relationship between anesthesiologists and the community and the role anesthesiologists play in perioperative treatment have. The Cuban health system services are in a process of permanent adaptation to the problems, demands and needs the Cuban population and its determinants have. For that reason, this paper aims at presenting theoretical considerations towards the improvement of the Anesthesiology and Resuscitation service. (shrink)

In 1962, Harvard professor of anesthesiology Henry Beecher wrote to Senator Estes Kefauver about certain additions to the federal Food and Drug Act then being considered. According to The Antibiotic Era, the Maryland congressman Samuel Friedel had introduced language that would require informed consent in clinical research. Beecher joined a number of other distinguished medical scientists warning that such a requirement would “cripple” American medical research. A year before, Beecher had protested the U.S. Army's inclusion of the Nuremberg Code (...) in its contracts. Beecher's commitment to a medical ethics of virtue rather than one of oversight suggests that he was a far more interesting person than the cardboard cutout so often vaguely referenced in bioethics as an icon of the rights of human subjects. His thinking about research ethics was rooted in his post‐World War II laboratory work with LSD. (shrink)

When I arrived at Harvard as an incoming graduate student in the fall of 1964, I soon received a telephone call from a gentleman who introduced himself as Henry Beecher. I was in the process of shifting my graduate studies from research neuropharmacology to the study of ethics. Robert Featherstone, the head of the Department of Pharmacology at the University of California Medical Center, San Francisco, where I had been studying, was a specialist in anesthesiology and knew Henry Beecher, (...) who was also working in anesthesiology, well. He had contacted Beecher, alerting him to the fact that a new graduate student was arriving and that it appeared that the two of us had much in common. The phone call from Beecher... (shrink)

Continuous sedation at the end of life is a practice that has attracted a great deal of attention. An increasing number of guidelines on the proposed correct performance of the practice have been drafted. All of the guidelines stress the importance of using sedation in proportion to the severity of the patient’s symptoms, thus to reduce the patient’s consciousness no more than is absolutely necessary. As different patients can have different experiences of suffering, the amount of suffering should, ideally, be (...) assessed subjectively; that is, via communication with the patient. Continuously sedated patients are often unable to communicate, however, making subjective methods of pain assessment unusable. For these patients, the degree of consciousness is the sole available measure. It therefore seems important to adequately measure how deeply the patient is sedated, thereby allowing sedation to be increased when it is too light and decreased when it is too heavy. This is in accordance with the idea that reducing consciousness is not an ethically neutral act.Although consciousness measuring techniques are a hot topic in anesthesiology, almost no research exists on the use of such techniques in the context of continuous sedation at the end of life. This article aims to review existing techniques to measure consciousness and to evaluate their applicability, efficiency, and invasiveness for patients who are continuously sedated until death.Techniques commonly used to assess the depth of sedation in continuously sedated patients are basic clinical assessment and sedation scales, as they are often considered reliable and noninvasive. These techniques might not be very reliable, however, since it is known that some patients are nonresponsive and yet aware. Moreover, sedation scales require stimulation of the patient (for example prodding, shaking, or providing painful stimuli), and can thus be considered invasive of one’s bodily integrity or dignity. Other techniques, such as EEG (electroencephalography) derivatives, may score better on reliability and invasiveness. Yet these have so far never been compared to sedation scale scores for patients receiving continuous sedation at the end of life.Therefore, we conclude that, for both clinical and ethical reasons, research into the efficiency and applicability of other techniques, such as derivatives of EEG, are urgently needed. (shrink)

Stuart Hameroff, M.D., is a doctor of medicine, a professor of anesthesiology and psychology, as well as associate director of the Center for Consciousness Studies at University of Arizona. Through a collaboration with mathematical physicist, Prof Sir Roger Penrose, Prof Hameroff is leading the assault on mainstream thinking about the human mind and how it is that we come to be. Forget space exploration. Forget biotechnology. Forget nanobots. Forget sea monkeys. The final frontier of science is reading this article (...) right now - and there's a very good reason why physicists call it "the hard problem".. (shrink)

Today we’re talking with Stuart Hameroff, Professor Emeritus at the Departments of Anesthesiology and Psychology, and Director of the Center for Consciousness Studies, at the University of Arizona. Dr Hameroff is best-known for his research on 'quantum consciousness', an alternative model to the accepted view of how consciousness arises. With Sir Roger Penrose, Dr Hameroff has proposed that consciousness arises at the quantum level within structures inside neurons, known as microtubules.

On June 16, 1966, the New England Journal of Medicine published “Ethics and Clinical Research” by Henry K. Beecher. Beecher’s account of 22 examples of unethical contemporary clinical research shook up the medical profession and helped pave the way for U.S. federal regulation of research involving human subjects. Five decades later, in this issue of Perspectives in Biology and Medicine, we pay tribute to the lasting significance of this whistle-blowing article and to the remarkable contributions of Henry Beecher. Beecher was (...) a pioneer in anesthesiology as an academic discipline and in research on pain and the placebo effect. He was an early and influential champion of randomized placebo-controlled... (shrink)

Philosophy and anaesthesiology are disciplines that are rarely associated despite their respective interests in human consciousness. In this paper, we consider the advantages of integrating anaesthesiology and philosophy in the endeavour of discovering the neural correlates of state consciousness. We venture the following twopart argument. First, we argue that philosophical debates about the correlation conditions for state consciousness can be improved by focusing on how anaesthesiologists actually measure and study consciousness in practice. We present Integrated Information Theory as a promising (...) framework for discriminating features hitherto considered relevant to the identification of the neural correlates of state consciousness. Second, we argue that an improved philosophical understanding of what comprises the correlation conditions for state consciousness can, in turn, advance anaesthesiological methodologies; not only can it improve how potential evidence is gathered and assessed, but it can aid in the prevention of intraoperative awareness, increasing patient safety and well-being. (shrink)