Anesthesia — Core of Discipline

C25 Recognizing and managing ethical dilemmas that arise in the course of patient care

- This EPA focuses on recognizing that an ethical issue may arise in the course of a patient’s care.
- This EPA includes identifying the issue and related ethical concepts and addressing the issue with the patient, family and/or health care providers while managing personal beliefs and/or values.
- Examples of patient scenarios may include a patient arriving to OR for a palliative operative procedure, a patient who identifies as Jehovah’s witness, a patient with severe comorbidity arriving for an elective procedure.
- The observation of this EPA is based on the submission of a reflective critique of a clinical case that posed an ethical issue. The critique must identify the clinical issue, the relevant ethical concepts and any relevant legal, professional or institutional statements, and describe the outcome and a lesson learned by the experience.
- The issue prompting the reflection may be a clinical experience, a simulation scenario or a case discussion.

Form

F4: Narrative

Milestones

• ME 2.3. Share concerns, in a constructive and respectful manner, with patients and their families about their goals of care when they are not felt to be achievable

• ME 2.4. Ensure treatment plans align with the patient’s expressed goals of care

• ME 3.3. Advocate for timely access for palliative surgical procedures

• COM 1.1. Communicate in a manner that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion

• COM 1.2. Optimize the physical environment for patient comfort, privacy, engagement, and safety

• COM 3.1. Convey the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and/or family

• COM 3.1. Discuss end of life care planning as it relates to anesthetic care when appropriate

• P 1.3. Manage ethical issues encountered in the clinical and academic setting

• P 1.3. Consider the impact of one’s own values, attitudes, beliefs, context and biases when dealing with ethical challenges and counselling patients

• P 3.1. Describe and apply the relevant codes, policies, standards, and laws governing physicians and the profession relevant to Anesthesiology and Critical Care Medicine including: capacity; substitute decision makers, guardianship, next of kin; living wills, legal directives; end of life care; spectrum & implications of do not resuscitate orders; withdrawal of care; and medical assistance in dying

• P 3.2. Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care profession

Context Variables

No context variables defined.

Requirements

• Review by supervisor of resident submission of a brief critique (max 2 pages) that identifies the clinical issue, the relevant ethical concepts, any relevant legal, professional or institutional statements and the outcome.
• Use Form 4
• Collect 1 observation of achievement