Should anesthesia for futile surgery be rejected?

If the anesthesiologist knows with certainty, according to the evidence-based medicine/guidelines, that the proposed surgery is not appropriate for the patient, what should be his/her role? Should he/she refuse or proceed with the anesthesia? Anesthesiologists, more than other specialists, are daily practinioners in medical ethics. Trying to understand and respect the ethical dimensions of medical care while preparing patients for life-altering surgery, dealing with acutely and chronically painful patients, caring for patients with multisystem organ failure and little chance for survival, witnessing perioperative deaths, caring for patients with do-not-resuscitate requests or other treatment limitations are all routine parts of anesthesiologists’ practice. Anesthesiologists are members of the operating team, and from an organizational point of view, surgery and anesthesia share mutual rules and responsibilities. Although the surgeons usually consider themselves to be the leaders of the team, all members, including the anaesthesiologists, have their own legal, ethical and professional responsibilities. In order to avoid that some physicians could use the concept of futility to unilaterally choose the most suitable type of treatment for the patient, the decision of “futile treatment” must be made by the various actors involved in the decision-making process: surgeon, anesthesiologist and patient. In line with the American Medical Association model, the procedure should aim to promote communication, minimise conflicts between the various actors (potentially) involved and avoid (where possible) polarisation of conflict and mobilisation of formal legal institutions. In case of irresolvable disagreement between doctor (or medical team) and/or patient (or representative), it should be possible to transfer the patient to a different doctor, medical team or institution willing to provide the intervention.