Justice for patients undergoing general anesthesia: A concept analysis

Abstract

Patients under general anesthesia experience a temporary loss of consciousness, autonomy, and the ability to self-advocate, leaving their safety entirely dependent on the perioperative team. In this setting, the principle of justice is often overshadowed by beneficence and non-maleficence. However, the concept of justice as it pertains to patients in this condition remains under-researched and has not been adequately explored in the existing literature. Therefore, this analysis aims to clarify and operationalize the concept of justice for patients undergoing general anesthesia. The process follows the eight-step framework developed by Walker and Avant. A comprehensive literature search was conducted across six online databases: PubMed, Scopus, ScienceDirect, Sage Journals, ProQuest, and Semantic Scholar. Included articles were published between 2015 and 2025 and specifically addressed the concept of justice for patients under general anesthesia. The PRISMA 2020 flow diagram was utilized to guide the article selection process. In total, 16 relevant articles were included for analysis based on the study's objectives. Data were analyzed using thematic synthesis to identify the defining attributes, antecedents, consequences, and empirical referents of justice. In the context of general anesthesia, justice is an ethical obligation to provide fair, impartial, and proportionate care that grounded in respect for patient dignity and rights, and reinforced by accountability in clinical decision-making. Key antecedents include patient vulnerability under anesthesia, clinical uncertainty, and resource constraints. The consequences encompass patient safety, professional integrity, and a strong organizational safety culture. To translate the concept into practice, the Perioperative Equity and Safety (PES) bundle is proposed. Given that justice is a fundamental ethical mandate in anesthesia care, it must be integrated into the functional reality of perioperative practice rather than remaining a theoretical ideal. The PES bundle provides an approach for embedding these principles into perioperative practice, strengthening safety and ethical accountability.

Keywords: Concept analysis, general anesthesia, justice, nursing practice, patient safety