Ethical and Philosophical Considerations in Thoracic Anesthesia

Abstract

Thoracic anesthesia is a rapidly evolving subspecialty and has witnessed unprecedented advancement in recent years for keeping pace with surgery on and inside the chest cavity [1]. Powered by social media dissemination platforms, the growing awareness among the afflicted masses that their difficult-to-treat infectious (e.g., empyema thoracis, tubercular lung consolidations/masses) and non-infectious (e.g., lung malignancy, mass, thyroid enlargement, thymoma) lung problems can be approached safely with minimal access (thoracic video-endoscopy) or open surgery (thoracotomy, lung transplant) intervention has led to a quantum jump in thoracic surgery turnover in the last decade. Further, recent advances in thorax-specific radio diagnostics (HR-computed tomography, MRI, CT angiograms) and laboratory studies (markers, gene expert) have greatly facilitated decisive selectivity in approach to thoracic surgery, thereby ensuring lesser post-surgery morbidity and improved surgical outcome. Combined together, the above-stated elements of current-day thoracic surgery have propelled a proactive transit of orthodox conservatism and dogma-driven [2] management options to clear reasoned indications to surgery. It is therefore very important that the members of the thoracic team (anesthesiologists, surgeons, intensivists) must always engage in contentiuos philosophical consideration/communication beforehand to reach at practical and ethical decisions that brings benefit to the patients and causes no/minimal iatrogenic and/or constitutional harm. Also, at the policy level, capacity building efforts to enhance infrastructure and expert human resource is the need of the hour to cover larger poulation at a lower cost per patient.