Chapter 30 - Ethical issues arising in airway management

Summary

This chapter discusses some aspects of airway management that may present ethical dilemmas. Seeking consent for anaesthesia should include a discussion of any specialist or non-routine airway techniques. Providing good information about procedures such as awake fibreoptic intubation and its intended benefits shows respect for patients' autonomy, and can help allay their anxiety. Patients with 'do not attempt resuscitation' (DNAR) decisions may also present for anaesthesia to allow palliative procedures to be performed, or feeding tubes to be placed. This can present a dilemma to anaesthetists regarding the extent to which the normal requirements of safe anaesthesia and airway management might contravene specific details of the DNAR decision. Anaesthetists and critical care clinicians may have to perform airway procedures such as percutaneous tracheostomy on incapacitated patients. Although the legal requirements for making this decision are reasonably clear, some ethical dilemmas are more complex.