Volume 10, No. 1 • Spring 1995

Moral Contract Outweighs Any Vigilance Debate

Shepard B. Stone, M.P.S., P.A.

To the Editor

I read with interest Lieutenant Colonel Bostek’s letter in the Winter 1994-95 issue of the APSF Newsletter.

I concur with his feelings about reading in the operating room. I also appreciate the feeling of his colleagues who believe that they can safely read in the OR. I’ve also heard claims that reading may serve to enhance vigilance (personally, Fm not sure how).

I feel that these arguments beg the issue. We, as anesthesia care providers, have entered into a moral contract with our patients. This contract implies that we will devote all of our efforts to their care when they have entrusted themselves to us in the operating room (or the delivery room, intensive care unit, emergency room, pain management clinic, or wherever). In good conscience, I don’t believe that any of us could read and not breach our covenant. I’ve not the eloquence of a philosopher, nor the knowledge of the law like an attorney, but I can’t help believe that it is wrong. I can’t imagine that our patients would be too pleased to find that their anesthesiologist or anesthetist was reading (whether it be a journal or a novel) wife providing anesthesia care. As an analogy, how would you feel if you found out that the pilot on your commercial airliner was reading instead of monitoring the controls, instruments, and other members of the flight crew?

I offer these thoughts as a teacher and practitioner with seventeen years experience (yes, and I am also a pilot). I offer for your readers’ consideration that if one cannot maintain the necessary vigilance in the operating room without reading, one should consider abandoning the practice of anesthesia. After all, I’ve heard concern that there is an overabundance of anesthesia care providers and this is one way to address that issue.

Maybe I’m just old-fashioned, but I am most respectfully yours,

Shepard B. Stone, M.P.S., P.A. Lecturer in Anesthesiology

Yale University School of Medicine

Physician, Associate Anesthesiologist Yale-New Haven Hospital