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Clinical ethics: what the anesthesiologist and the intensivist need to know.

Clinical ethics if often perceived as an intuitive understanding of what is right versus wrong. This is insufficient for healthcare workers in general, but particularly for anesthesiologists and intensivists, who often must weigh up complex and emergent life or death decisions and subsequently justify these decisions to their team and patients, as well as patient's families. Articulating the rationale for such decisions is an arduous task. Thus, a brief introduction to the basic conceptual framework and vocabulary of clinical ethics may be useful to this population of physicians. The most important concept is that interventions offered should be both clinically appropriate and ethically proportionate, desirable by both the patient and the medical team, and offering a meaningful benefit to the patient within the context of his or her own life narrative. This puts an emphasis on understanding, from the patient or his/her proxies, not just who the patient is biologically but also biographically: that is what gives meaning to his/her life subjectively, and what quality of life would be compatible with this level of functioning, as well as when he/she would wish life sustaining therapy to be withheld or withdrawn.