Ethical decision making in airway management: a difficult Airway Society position statement on good practice

Abstract

Practitioners involved in airway management must balance ethical issues in their practice. Ethical tensions exist because clinicians must maintain clinical standards while maximising skill development, exploring advances in airway practice, and incorporating new learning to benefit future patients. Balancing the benefits and risks to the patient and choosing the right techniques in the right situations and with the right level of patient understanding and respect for patient autonomy can be challenging. These challenges are shared by airway practitioners from many professional backgrounds; however, this document has been developed specifically to support anaesthetists in their airway management decisions, and for simplicity, the term 'anaesthetists' will be used throughout the document. However, the ethical considerations will have relevance to all airway practitioners. Practice combined with training is central to professional development. Most patients are aware that training is entwined with care and trust anaesthetists to deliver this safely. Trainers should use airway teaching methods appropriate to the trainee's needs and skills. Informed consent is required for airway management, and the level of detail should be proportionate to the risks involved. Patients have individual preferences and appreciation of risks, so these conversations must be individualised. Anaesthetists should support the development of new airway devices and techniques. New methods must be assessed within governance structures, and it may be appropriate to collect data or feedback as part of the introduction to practice. Ethical practice requires doing what is best, doing it openly, honestly, and in patients' interests. The modern ethical and legal landscape has emphasised patient information, discussion, and documentation. We hope this position statement provides guidance, structure, and clarity for the benefit of our patients and our specialty.

Keywords: airway; consent; ethics; innovation; training.

Fig 1

A flowchart to guide the choice of an appropriate airway device and technique.

Fig 2

A flowchart on the steps recommended when introducing new airway devices or techniques. CE, Conformité Européenne; UKCA, UK Conformity Assessed.

Fig 3

A checklist for preparing to introduce a new airway device or technique. CE, Conformité Européenne; UKCA, UK Conformity Assessed.

Fig 4

Stepwise progression of the steps associated with learning a new skill and how they relate also to the Royal College of Anaesthetists' designated levels of supervision.

Fig 5

The key points of an ethically informed airway training framework.

Fig 6

Multi-faceted considerations for ethically informed airway management. CE, Conformité Européenne; DAS, Difficult Airway Society; R&D, research and development; RCoA, Royal College of Anaesthetists; UKCA, UK Conformity Assessed.