Blogs

For over a decade, Dr. Stephen Jackson served as chair of the ASA Committee on Ethics, and he served for over three decades as a member on both the ASA Committee on Occupational Health and the ASA Committee on Physician Well-Being. It’s a powerful trifecta of interests that, unsurprisingly, has yielded a thoughtful and well-rounded career in anesthesiology. In this Member Spotlight, he shares his approach to tackling life’s thorniest questions — with professional rigor and a healthy dose of humor.

---

You’ve previously chaired both ASA’s Committee on Ethics and the bioethics committee at your hospital. What first got you interested in the ethical practice of anesthesiology and how do you view your contributions in this area?

In addition to OR and OB anesthesiology, I practiced critical care in both academic and community tertiary care hospitals. From the earliest of these times, I became involved in what is best described as the “humanistic medicine” movement, one that offers a framework of modern medicine that satisfies the needs of the human condition, one that nurtures the need to express the values and qualities that make the practice of medicine humanely relevant and effective, and in particular, one that emphasizes the importance and benefit – for both the patient and the physician – of the doctor-patient relationship.

In 1992, to address the rising frequency of clinical ethical challenges that anesthesiologists were encountering, ASA resurrected its previously abandoned Committee on Ethics, whose primary goal had been promoting the economic well-being of our specialty. Because of my interest in humanism, which assuredly has its share of ethics and morals, I was appointed to chair and guide this committee, spanning its initial decade.

My contributions were in large part that of orchestrating the contributions of our committee’s brilliant and dedicated community of anesthesiologist-ethicists. Collectively, we created the Guidelines for the Ethical Practice of Anesthesiology, the Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders or Other Directives That Limit Treatment, and other ethically relevant documents.

You are the author of numerous publications and continue to publish articles on ethics and anesthesia. Is there a particular article or paper that you feel especially proud of?

Choosing an article of which I am most proud is challenging because much of my published work has focused on largely unexplored arenas in our specialty, but not solely ethics, so I prefer to share several of my “favorites” across the broader range of our specialty.

For ethical topics:

• “Anesthesia, Anesthesiologists and Modern Medical Ethics” (chapter in Eger, Saidman and Westhorpe’s Wondrous Story of Anesthesia), co-authored with Gail Van Norman
• Chapters in three publications on violations of research and publication ethics, again co-authored with Gail Van Norman (Clinical Ethics in Anesthesiology, Ethical Issues in Anesthesiology and Surgery, and ASA's Ethics Handbook: An Educational Resource for the Practice of Anesthesiology)
• Seminal articles on the harmful effects of excessive stress on the well-being of anesthesiologists; my two “favorites” found in Seminars in Anesthesia, 1993, and Acta Anaesthesiologica Scandinavica, 1999

For topics unrelated to ethics:

• "Transdermal scopolamine as a pre-anesthetic drug and postoperative anti-nauseant and antiemetic" (Anesthesiology, 1982), short-listed for one of “The 20 Most Important Anesthesia Articles Ever Published” (Anesthesia and Analgesia, 2015)
• Pioneering studies on the in vitro and in vivo toxic effects of anesthetic drugs, including developing a clinical protocol at the NIH for studying and confirming methoxyflurane nephrotoxicity, that later was brought to fruition with colleagues at Stanford (published in Pharmacologist in 1970 and later in JAMA in 1971)

You’re also a past president of the California Society of Anesthesiologists. Can you tell us a bit about that leadership role and what you were able to accomplish there?

During my presidency of the CSA, the major issue that I tried to address was to improve physician well-being, both personal and professional, with particular focus on enhancing our awareness of excessive stress and its harmful consequences (burnout, chemical dependence, depression and suicide), which at that time were neither well known nor appreciated.

While I spoke to the importance of bolstering physician coping and resilience, I also pointed to the toxicity of the work environment. At the same time, I spoke to medicine’s dehumanization and depersonalization of our patients. Dehumanization implies that human beings may be perceived and treated in ways that do not realistically acknowledge their human quality and unique identity and, importantly, this also applies to physicians’ overview of themselves. I strongly believe that the erosion of the doctor-patient relationship is closely linked to the epidemic of stress and burnout.

You write on your ASA Community profile that you are “interested in the role of humor in personal and professional lives through its contribution to physician stress management and well being.” How has this approach helped you in your own life?

Nurturing my sense of humor, silliness and playfulness has been a major coping strategy in managing the inevitable stresses and strains of both my personal and professional lives. A sense of humor involves adopting a playful frame of mind, an ability to perceive, appreciate, and express what is funny, amusing, or even ludicrous. It is a form of play with ideas, of reframing life’s experiences with less distressing perspectives.

Humor establishes a mood or attitude that predisposes to being spontaneous and can, when appropriate, introduce positive emotion and fun into what we are doing. It gives us power, encouragement, perspective, and a sense of balance as it facilitates our creativity in finding ways to alleviate stress. Moreover, humor is a unique human attribute that can be helpful, again when appropriate, with initiating and cultivating the doctor-patient relationship, enhancing meaningful communication and collaboration, and reducing stress for both parties.

Finally, you have mentored many young anesthesiologists over the years. What advice do you have for those just beginning their careers, based on the many experiences you’ve had over the course of yours?

Medicine and anesthesiology have little semblance to when I entered over 60 years ago. Nonetheless, I remind younger anesthesiologists that medicine is a noble calling, and an art as well as a science, an imaginative, creative, and rewarding way of healing the ailing human being.

Unfortunately, modern medicine perceives and treats patients in a manner that fails to acknowledge their humaneness, and this also applies to physicians’ views of themselves. In this era of cost containment and an ensnarling web of production pressures in a toxic work environment, the opportunity for anesthesiologists to achieve a mutually beneficial humanistic interaction with their patients (and their families) is diminishing. Forgoing serving as healers who provide comfort, empathy, and reassurance while earning our patients’ trust and confidence can lead to the loss of a hallowed medical rite.

Abraham Verghese wrote, the physician-patient interaction, “when viewed as ritual, is a reenactment of a healing scene that has played out through recorded history: one individual with expertise, anointed by society … attempts to relieve the suffering of another.” Unless our younger generation strives to retain and cultivate this human factor, our profession, as I have known it, is less likely to thrive.

A graduate of Princeton University and Harvard Medical School, Stephen Jackson, MD interned at Bellevue Hospital, had his residency at Massachusetts General Hospital, followed by two years at National Institutes of Health Clinical Center, five years on Stanford faculty, and the next five decades at a tertiary care hospital in San Jose. Within ASA, he chaired the modern Ethics Committee for its initial decade, chaired the Clinical Forum for two terms, and served as a member of the Committees on Occupational Health and Physician Well-Being for three decades. He has the “blessing of three loving and caring daughters and son, and five wonderful and beautiful granddaughters,” all residing within a half hour of his home.

#MemberSpotlight
#PhysicianWellness
#MedicalEthics