Editorial

D espite the frequent contact between anesthesiology and the law, it is relatively rare for our specialty to become involved with ethical issues other than those dealing with the responsibility to resuscitate a specific patient. In this issue of Anesthesia & Analgesia, an article raises two additional ethical principles-patient autonomy and distributive justice. Arguably, the legal authority cited by the authors promotes concepts that challenge basic tenants of ethical care. The paper in question, “Preoperative Pregnancy Testing in Adolescents” (11, examines the incidence of positive urine tests in a cohort of young women admitted to a pediatric hospital for elective surgical procedures. Testing was performed without patient consent, as it was deemed a mandatory component of the preoperative evaluation and had been approved by the medical staff of the hospital because “anesthesiologists consider this test to be a necessary condition for a safe anesthetic.” The test was positive in 5 of 412 postmenarchal subjects (between the ages of 10 and 20 yr) for an overall incidence of 1.2%. All those testing positive were 16 yr of age or older giving an incidence of 2.4% in those over the age of 15 yr. In three subjects, the surgical procedure was postponed, in one it was performed under local anesthesia, and in another a general anesthetic without N,O was administered. The authors conclude that “a policy of mandatory pregnancy testing in pediatric patients aged 15 yr and older is advisable. Specific written consent is not necessary, but proper notification processes must be established.” testing was determined to be part of the routine admission protocol for all admissions, specific consent was unnecessary. They further advise that the answer to the additional legal question that arises with a positive result, “Do I inform the parents if the child is pregnant?” varies between jurisdictions and that anesthesiologists should obtain independent legal advice before implementing their policy. In the authors’ geographical area, an “emancipated adult” (a minor who is married, already a parent, or by his or her own lifestyle has assumed responsibility for his or her own life) would be informed directly and without involvement of the parents; however, the physician may advise the parent or guardian without violation of the patient’s right to confidentiality. Not all of us consider all legal opinion to be fair and ethical. Although law is grounded in societal ethics, not all ethics are expressed in law. Commonly, legal statements of fact, based on common law precedence, may be at odds with societal expectations. Lawyers may advise that we may perform unexplained tests on minors without fear of litigation, but such an opinion does not grant societal permission.