Mandatory training for rare anaesthetic events – a virtue ethics view

Abstract

I read with interest the letters by Murphy [1] and Frerk and Evans [2] about philosophical approaches to mandatory training for rare anaesthetic events. The utilitarian and Kantian philosophical approaches that they advocate highlight the importance of striving for good outcomes when rare anaesthetic emergencies occur, as well as aiming for universal anaesthetic competence in managing these situations. However, as duty-based philosophical approaches, both utilitarianism and Kantianism consider the right action to be solely an individual's responsibility. Systems-based and human factors approaches to the management of anaesthetic emergencies highlight that the factors that influence decision-making, performance and outcome in these situations are much more extensive than the decision-making of individuals in the moment [3]. Virtue ethics offers a different philosophical approach, emphasising the importance of mandatory training and simulation that provide opportunities to prepare to respond correctly to rare anaesthetic events as clinical teams, not just as individuals.

Virtue ethics seeks to understand correct action in the context of being a good (or virtuous) person. Aristotle, one of the most influential ancient virtue ethicists, considered education and training to be fundamental to the development of both excellence in practical skills and virtuous characters, which may both be necessary to respond rightly to life's moral challenges [4]. This means that virtuous action is not something that can simply be achieved in the moment that an ethical dilemma arises. Virtuous acts occur when people who have trained in skills and developed good character traits are prepared to respond appropriately to the challenges they face. This suggests that virtuous anaesthetists should be interested in developing excellent technical skills and virtuous characteristics, like vigilance, composure and adaptability, so they are prepared to respond to rare anaesthetic events correctly.

Swanton (a modern virtue ethicist) has argued that developing team-working (dialogic) virtues promotes the collaboration required to overcome the complex problems we encounter in life and our own individual limitations [5]. Simulation training offers an important opportunity to grow in these virtues and to develop ways of working together effectively as teams to identify and manage rare anaesthetic events. Virtue ethics highlight the moral importance of ensuring good human factors approaches to our multidisciplinary team-working, if we hope to respond with excellence and virtue when rare anaesthetic events occur. Mandatory training and simulation can both be ways in which anaesthetists and the teams they work within can prepare virtuously for rare anaesthetic emergencies.