Anaesthesia consent in public hospital population - An ethical dilemma.

Abstract

Sir, I read with interest the article published by Kumar et al.[1] in your esteemed journal. I would like to commend the authors for summarising an issue that is extremely important considering the increasing incidence of medico-legal litigations under consumer protection act. Anaesthesia and anaesthesiologists are usually blamed, when surgical deaths are under litigations. I am writing to bring to the notice of the readers and authors, another closely related issue – Awareness about Anaesthesia. Although some of us work in private hospitals with well-informed patients, there is a section of our patients who are not so privileged. These patients do not have the resources to sue or question why they were not properly informed, but for the most part, trust in our judgement and decisions. Multiple studies[2,3,4,5] have been done in Indian public hospital population to find out the quantum of basic information about anaesthesia that the people had in public hospitals of India who were undergoing surgery. Attempts have been made to analyse whether patients were aware about anaesthesia and relevant issues such as type, who administers anaesthesia, anaesthesia as a speciality and importance of consent. Although a full discussion of the results is beyond the scope of this letter, it was disheartening to discover that only about 10–30% of uneducated public hospital population knew about anaesthesia as a physician speciality.[2,3] All these studies uniformly confirmed that education was significantly related to awareness about anaesthesia. Singh et al. highlighted another interesting finding in rural population: About 83.6% patients were not aware of contents of pre-operative consent they had signed.[5] In view of the above-mentioned findings, I would like to stress on the point Kumar et al. underlined – ‘Consent should be informed’. Consent paper work in local language may be beneficial in educating our patients, though this will need to be a state-based system change to avoid potential legal complications. Another consideration is the poor healthcare staff–patient ratio and overworked resident physicians in majority of the public hospitals. This might be a road block in our attempt to improve the awareness about our speciality in public hospital population. Despite the evolution of anaesthesia as a speciality in the last few decades, by leaps and bounds, people have misconceptions and at times are totally ignorant about this speciality. Therefore, it is imperative that we not only inform people about the details and risks of anaesthesia that they will be undergoing, but also educate them about our speciality which is not therapeutic, but plays a vital role in the surgical outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.