Heather Draper and Wendy Scott . Ethics in anaesthesia and intensive care. Butterworth Heinemann (Elsevier Science), Edinburgh, 2003, pp 243, ISBN 07506 5353 1

The foreword to this book describes ethics as “the philosophical study of the moral value of human conduct and of the rules and principles that ought to govern it.”

Medical personnel in the fields of anaesthesia and intensive care are often required to treat patients who are unconscious or semiconscious and incapable of taking informed decisions. In such situations, the time available to have a detailed discussion with the accompanying relatives may be limited. The editors have chosen 17 specialists to discuss the various dilemmas faced by specialists who work in these fields.

The authors start by introducing the theories that form the moral basis of ethics and the fundamental principles based on legal and social reflections that motivate the practice of ethics.

The book includes two chapters that deal with the nuances of informed consent. The practice of informed consent has undergone several changes in the last 30 years. Consent is now also required for the extension of any procedure. Children are a particularly vulnerable group of patients because they are usually not in a position to understand the implications of the procedure.

The book asks if information related to a patient in an ICU is confidential. The technological advancements in ICUs and their open structure allow many specialists to sift through the data, which makes it difficult to maintain confidentiality. Two chapters in the book review the ethical and legal aspects of the confidentiality of information. Laws in the UK protect the right to privacy but a range of ethical and legal issues must be considered when information is sought by a competent authority or by other care givers. In the Indian context, it would be interesting to discuss what the Right to Information Act says about this subject.

The ICU is an area of ethical conflict. Treatment often depends on a team’s judgement and it may include invasive or expensive procedures. A consensus that involves the relatives may become necessary. Withholding or withdrawing life support systems sometimes requires knife-edge decisions. In such circumstances, what is right and what is ethically unacceptable becomes a matter of judgement.

The book also discusses the rights of the foetus. The dilemmas about administering epidurals to a pregnant woman who has received oral or injected analgesics are highlighted in another chapter. The book delves into how much information is the right amount and argues that better compliance is ensured if there is adequate information.

Three other chapters discuss the functioning of ethics committees and research ethics. The funding of research and resource allocation in critical care is a like a tight rope-walk for the doctor and the administrator. The book also talks about the parameters of brain death. Should there be a tenacious effort to keep alive a brain dead patient? Does brain death necessarily follow cardiac arrest?

Dilemmas that the intensivist faces in daily practice are discussed with illustrations and legal opinions. Several ethical questions are raised if we think of giving anaesthesia for organ retrieval in a brain dead patient. This practice may become common in India and its ethics will be an issue.

An increased awareness of blood borne communicable diseases has resulted in new problems with routine testing. Some specialists suggest that autonomous opinions should not hamper the testing process. It is argued that the routine testing of antenatal patients can be extended to other groups. Can this be done covertly? It is difficult to give a definitive answer, especially in the Indian context.

The book includes a chapter on ethics education for the doctor in training. Another chapter on ethics in private practice may be instructive, though it speaks of the British context. On the whole, the book is a useful manual for anyone involved in anaesthesia and critical care.