Preoperative testing: Ethical challenges, evidence-based medicine and informed consent

Abstract

Preoperative medical testing for anesthesia and surgery presents certain ethical challenges. Medical evidence suggests that most preoperative testing is unnecessary and may actually harm patients, violating the ethical principle of nonmaleficence. When preoperative testing is done, the anticipated true benefits and possible harms should be disclosed to the patient, as with any medical decision. Certain tests, such as pregnancy and HIV (human immunodeficiency virus) testing require particular care in the informed consent process, because they may be affected by the explicit legal rights of the patient. When patients refuse preoperative testing, the physician should generally respect the patient’s decisions unless it would lead to care that is bizarre, futile, or below published professional standards.