Lessons from history: Horace Wells and the moral features of clinical contexts

Horace Wells first used nitrous oxide for anesthetic purposes in December 1844. Although his life ended tragically in 1848--and before he received official recognition for his work--Wells' significance in the history of anesthesiology is now firmly established. One hundred fifty yr later, the story of his discovery may also be seen as having significance in terms of ethical issues in health care, particularly as regards clinical decision making. Wells' story provides an example of how the moral dimensions of actions taken in the health care setting can be understood only in the context of the individual, clinical, institutional, and political arenas in which they occur. Resolving ethical conflicts and dilemmas thus requires clinicians to pay attention to such factors as personal, professional, institutional, and broader social, political, and economic considerations that influence what one believes to be "best" in given circumstances.