Alyssa Burgart (she/her)
Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Clinical Associate Professor (By courtesy), Pediatrics
Bio
Dr. Alyssa Burgart is a unique figure in the fields of pediatric anesthesiology and bioethics, with double board certification in anesthesiology and pediatric anesthesiology and over 20 years of experience in bioethics. Her role as a clinical associate professor at Stanford University in Anesthesiology, Perioperative, and Pain Medicine, and by courtesy in Pediatrics, underscores her interdisciplinary approach. This is further evidenced by her affiliation with the Stanford Program in Feminist, Gender, and Sexuality Studies in the School of Humanities and Sciences.
Dr. Burgart holds numerous leadership positions, including Associate Director of Pediatric Bioethics at the Stanford Center for Biomedical Ethics, Medical Director of Ethics for the Stanford Medicine Children’s Health, and physician co-chair of the Stanford Children’s Ethics Committee. She actively supports the Program in Medical Humanities and the Arts and is the Associate Director for Symposium. In the undergraduate school, she teaches a course called One in Five: The Law, Politics, and Policy of Campus Sexual Assault.
Dr. Burgart is an expert in difficult conversations and skillfully mediating complex choices with families and healthcare providers. She speaks nationally on bioethics, relationship-centered care, trauma-informed care, disability justice, gender equity, and reproductive justice issues.
Dr. Burgart's dedication to pediatric trauma mitigation is unwavering. She is committed to finding the most successful way for each child to interact with the anesthesia team, ensuring an overall positive experience and reducing the risk of medical trauma. She advocates specifically for children with unique needs, such as those with unique sensory integration needs. Her clinical focus within pediatric anesthesiology is on abdominal transplant anesthesiology, specifically on children weighing less than 10 kilograms (22 lbs).
Her current research projects are grounded in the just delivery of care: pediatric justice (especially pediatric algorithmic bias), mitigating moral distress and moral injury, reproductive care access (including anesthesiologists as barriers to access), and workplace violence prevention.
Dr. Burgart's influence in the field of bioethics extends beyond her clinical and academic roles. As an associate editor and digital media editor at the American Journal of Bioethics, her work is instrumental in shaping the discourse on ethical healthcare practices. Her writing, featured in JAMA, The Washington Post, USA Today, Slate, and Ms. Magazine, and her newsletter, Poppies & Propofol, are all part of her mission to enhance public education on bioethics issues in the news. She frequently engages with journalists to ensure accurate and comprehensive reporting on complex medical ethics issues.
Clinical Focus
- Bioethics
- Pediatric Bioethics
- Pediatric Anesthesia
- Anesthesia for Liver Transplant
Academic Appointments
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Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
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Clinical Associate Professor (By courtesy), Pediatrics
Administrative Appointments
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Associate Director of Pediatric Bioethics, Stanford Center for Biomedical Ethics (2024 - Present)
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Co-Chair, Clinical Ethics Committee, Stanford Medicine Children's Health (2016 - Present)
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Associate Director of Symposium, Stanford Medical Humanities and the Arts Program (2021 - Present)
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Member at Large, Medical Executive Committee, Lucile Packard Children's Hospital (2020 - 2023)
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Member, Ethics Committee, Stanford Medicine Children's Health (2015 - Present)
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Member, Ethics Committee, Stanford Hospital and Clinics (2015 - Present)
Honors & Awards
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Award for Exceptional Clinical Care, Anesthesia Professional Practice Evaluation Committee (Anesthesia PPEC) (November 2021)
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2024 Faculty of the Year, Pediatric Anesthesiology Fellowship, Stanford University School of Medicine (2024)
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2023 IMPACT Award, American Medical Women's Association (2023)
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2022 Stanford Children's Impact Award, Lucile Packard Children's Hospital at Stanford (2022)
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Award for Exceptional Clinical Care, Pediatric Critical Care Medicine Professional Practice Evaluation Committee (PCCM PPEC) (2021)
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2020 Faculty of the Year, Pediatric Anesthesiology Fellowship, Stanford University School of Medicine (2020)
Boards, Advisory Committees, Professional Organizations
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Co-Chair, Pediatric Ethics Affinity Group, American Society for Bioethics and Humanities (2024 - Present)
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Member, American Society for Bioethics and Humanities (2009 - Present)
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Committee on Bioethics, American Society of Anesthesiologists (2021 - Present)
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Member, American Society of Anesthesiologists (2014 - Present)
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Member, Society for Pediatric Anesthesia (2015 - Present)
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Member, California Society of Anesthesiologists (2014 - Present)
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Member, Women in Anesthesiology (2022 - Present)
Program Affiliations
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Feminist, Gender, and Sexuality Studies
Professional Education
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Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2016)
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Board Certification, Pediatric Anesthesia, American Board of Anesthesiology (2016)
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Board Certification: American Board of Anesthesiology, Anesthesia (2015)
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Fellowship: Lucile Packard Children's Hospital (2015) CA
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Residency: Loyola University Medical Center (2014) IL
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Internship: Loyola University Medical Center (2011) IL
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MA, Loyola University Chicago, Bioethics and Health Policy (2010)
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Medical Education: Loyola University Stritch School of Medicine (2010) IL
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BA, University of Judaism, Bioethics (2003)
2024-25 Courses
- One in Five: The Law, Politics, and Policy of Campus Sexual Assault
FEMGEN 143, SOC 188, SOC 288 (Spr) -
Prior Year Courses
2023-24 Courses
- One in Five: The Law, Politics, and Policy of Campus Sexual Assault
FEMGEN 143 (Spr) - One in Five: The Law, Politics, and Policy of Campus Sexual Assault
LAW 7065 (Spr) - One in Five: The Law, Politics, and Policy of Campus Sexual Assault
SOC 188, SOC 288 (Spr)
- One in Five: The Law, Politics, and Policy of Campus Sexual Assault
Graduate and Fellowship Programs
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Pediatric Anesthesia (Fellowship Program)
All Publications
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Chemical Restraints for Obstetric Violence: Anesthesiology Professionals, Moral Courage, and the Prevention of Forced and Coerced Surgeries.
The American journal of bioethics : AJOB
2024; 24 (2): 4-7
View details for DOI 10.1080/15265161.2024.2299629
View details for PubMedID 38295250
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Physician Unionization: Opportunities and Challenges for Anesthesiologists in the United States.
Anesthesia and analgesia
2023
Abstract
Physician unionization is gaining traction in the United States, with <10% of practicing physicians now members, up from historically weak support. Factors that drive interest in unions include a decreased number of independent practitioners, an increase in workloads, and the erosion of autonomy. Approximately 56% of anesthesiologists are considered employees and may be eligible for union membership. Physician unions may provide higher wages, better working conditions, and legal protection. However, they also raise concerns about patient care and professionalism. This article discusses the legal and regulatory framework governing the unionization of physicians, benefits, challenges, and potential future developments. Continued analysis and debate are necessary to determine the optimal role of physician unions in the health care industry.
View details for DOI 10.1213/ANE.0000000000006852
View details for PubMedID 38091478
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Recommendations for the use of pediatric data in artificial intelligence and machine learning ACCEPT-AI.
NPJ digital medicine
2023; 6 (1): 166
Abstract
ACCEPT-AI is a framework of recommendations for the safe inclusion of pediatric data in artificial intelligence and machine learning (AI/ML) research. It has been built on fundamental ethical principles of pediatric and AI research and incorporates age, consent, assent, communication, equity, protection of data, and technological considerations. ACCEPT-AI has been designed to guide researchers, clinicians, regulators, and policymakers and can be utilized as an independent tool, or adjunctively to existing AI/ML guidelines.
View details for DOI 10.1038/s41746-023-00898-5
View details for PubMedID 37673925
View details for PubMedCentralID PMC10482936
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Violence in the pain clinic: the hidden pandemic.
Regional anesthesia and pain medicine
2023
Abstract
Workplace violence is any physical assault, threatening behavior or other verbal abuse directed toward persons at work or in the workplace. The incidence of workplace violence in healthcare settings in general and more specifically the pain clinic is thought to be underestimated due to hesitancy to report, lack of support from management and healthcare systems, and lack of institutional policies as it relates to violence from patients against healthcare workers. In the following article, we explore risk factors that place clinicians at risk of workplace violence, the cost and impact of workplace violence, how to build a violence prevention program and lastly how to recover from violence in the practice setting.
View details for DOI 10.1136/rapm-2022-104308
View details for PubMedID 36754543
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Loss of access to legal abortion in America: history, implications, and action items for anesthesiologists.
Anaesthesia, critical care & pain medicine
2022: 101125
View details for DOI 10.1016/j.accpm.2022.101125
View details for PubMedID 35803575
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Physician Sexual Assault: The Moral Imperative for Gender Equity in Medicine
AMERICAN JOURNAL OF BIOETHICS
2019; 19 (1): 4–6
View details for DOI 10.1080/15265161.2018.1552036
View details for Web of Science ID 000456689000003
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Resuscitate but not Intubate? Partial Codes in Pediatrics.
Pediatrics
2023
Abstract
The use of partial code status in pediatric medicine presents clinicians with unique ethical challenges. The clinical vignette describes the presentation of a pulseless infant with a limited life expectancy. The infant's parents instruct the emergency medicine providers to resuscitate but not to intubate. In an emergency, without a clear understanding of parents' goals, complying with their request risks an ineffective resuscitation. The first commentary focuses on parental grief and how, in certain circumstances, a partial code best serves their needs. Its authors argue that providers are sometimes obligated to endure moral distress. The second commentary focuses on the healthcare team's moral distress and highlights the implications of a relational ethics framework for the case. The commentators emphasize the importance of honest communication and pain management. The final commentary explores the systems-level and how the design of hospital code status orders may contribute to requests for partial codes. They argue systems should discourage partial codes and prohibit resuscitation without intubation.
View details for DOI 10.1542/peds.2022-058931
View details for PubMedID 37435669
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Keeping an Open Mind About Open Notes: Sharing Anesthesia Records With Patients.
Anesthesia and analgesia
2022; 135 (4): 697-703
Abstract
ADDENDUM: Please note that in the interim since this paper was accepted for publication, new governmental regulations, pertinent to the topic, have been approved for implementation. The reader is thus directed to this online addendum for additional relevant information: http://links.lww.com/AA/E44.
View details for DOI 10.1213/ANE.0000000000005800
View details for PubMedID 36108183
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Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities.
Obesity surgery
2021
View details for DOI 10.1007/s11695-021-05393-y
View details for PubMedID 33797732
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Poorly conducted science is unprofessional.
Journal of vascular surgery
2020
View details for DOI 10.1016/j.jvs.2020.07.080
View details for PubMedID 32958318
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Elective Surgery and COVID-19: A Framework for the Untested Patient.
Annals of surgery
2020
View details for DOI 10.1097/SLA.0000000000004474
View details for PubMedID 32889879
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Parents Demand and Teenager Refuses Epidural Anesthesia.
Pediatrics
2020
Abstract
A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.
View details for DOI 10.1542/peds.2019-3295
View details for PubMedID 32398328
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Donor heart selection during the COVID-19 pandemic: A case study
JOURNAL OF HEART AND LUNG TRANSPLANTATION
2020; 39 (5): 497–98
View details for Web of Science ID 000535430200015
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Machine Learning Implementation in Clinical Anesthesia: Opportunities and Challenges.
Anesthesia and analgesia
2020
View details for DOI 10.1213/ANE.0000000000004656
View details for PubMedID 31922996
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How Anesthesiologists Experience and Negotiate Ethical Challenges from Drug Shortages.
AJOB empirical bioethics
2020: 1–8
Abstract
In the face of ongoing drug shortages, anesthesiologists have been described as having to become "Iron Chefs, challenged to create safe patient outcomes with missing ingredients. Unfortunately, developing responsive ethical guidance for how anesthesiologists should best handle ethical concerns with ongoing and mutable drug shortages is limited by the dearth of studies examining how bedside clinicians actually experience drug shortages and what ethical challenges they encounter. In order to better understand what ethical concerns individual anesthesiologists experience around drug shortages and how they negotiate them, we undertook this qualitative interview study. Methods: We conducted semi-structured interviews with anesthesiologists at three field sites: an academic tertiary care adult hospital that performs approximately 46,000 anesthetics annually comprising cases ranging across all surgical disciplines; the affiliated veteran's affairs hospital that performs 12,000 anesthetics annually; and, the affiliated children's hospital that performs 20,500 anesthetics annually. Results: 29 anesthesiologists were interviewed (17 adult and 12 pediatric anesthesiologists), representing a spectrum of practice areas in clinical anesthesia: general, pediatric, regional, pain, critical care, obstetrics, liver transplant, and palliative medicine. Three themes emerged: (1) uncertainty about responsibility for clinical decisions made in consequence to a shortage; (2) creativity, and its limits, in choosing anesthetic plans; and, (3) disclosure of concerns about shortages (to patients and colleagues). Conclusions: Our data suggests anesthesiologists have unmet needs for ethical guidance on how to approach drug shortages. First is managing responsibility for decisions stemming from a drug shortage. Second, interviewees struggled with disclosure of their concerns, both to patients and to surgical colleagues. A formal shared decision making approach may present the best solution, since the act of structuring a shared decision making conversation or creating a decision making tool will have to incorporate the views of all stakeholders around shortages and their potential clinical consequences.
View details for DOI 10.1080/23294515.2020.1839596
View details for PubMedID 33124970
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Resource Allocation in COVID-19 Research: Which Trials? Which Patients?
The American journal of bioethics : AJOB
2020; 20 (7): 86–88
View details for DOI 10.1080/15265161.2020.1779392
View details for PubMedID 32716767
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The opioid crisis should lead pediatric anesthesiologists to a broader vision of opioid stewardship.
Paediatric anaesthesia
2019; 29 (11): 1078–80
View details for DOI 10.1111/pan.13730
View details for PubMedID 31677337
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Scarlet A (Book Review)
AMERICAN JOURNAL OF BIOETHICS
2019; 19 (10): W3–W4
View details for DOI 10.1080/15265161.2019.1655956
View details for Web of Science ID 000487986000003
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Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians' perspectives and practices
PEDIATRIC TRANSPLANTATION
2019; 23 (3)
View details for DOI 10.1111/petr.13359
View details for Web of Science ID 000476931300005
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Managing Expectations: Delivering the Worst News in the Best Way?
The American journal of bioethics : AJOB
2018; 18 (1): 1–2
View details for PubMedID 29313792
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Ethical Challenges Confronted When Providing Nusinersen Treatment for Spinal Muscular Atrophy.
JAMA pediatrics
2018; 172 (2): 188–92
Abstract
The US Food and Drug Administration's December 2016 approval of nusinersen for the treatment of patients with all subtypes of spinal muscular atrophy ushered in a new era for patients with spinal muscular atrophy, their families, and all those involved in their care. The extreme cost of the medication and the complicated logistical requirements for administering nusinersen via lumbar puncture have created practical challenges that raise important ethical considerations. We discuss 6 challenges faced at the institutional level in the United States: cost, limited evidence, informed consent, treatment allocation, fair distribution of responsibilities, and transparency with stakeholders. These challenges must be understood to ensure that patients with spinal muscular atrophy benefit from treatment, are protected from harm, and are treated fairly.
View details for PubMedID 29228163
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Ethical Controversy About Hysterectomy for a Minor.
Pediatrics
2017
Abstract
One of the most complicated ethical issues that arises in children's hospitals today is the issue of whether it is ever permissible to perform a procedure for a minor that will result in permanent sterilization. In most cases, the answer is no. The availability of good, safe, long-acting contraception allows surgical options to be postponed when the primary goal of such surgical options is to prevent pregnancy. But what if a minor has congenital urogenital anomalies or other medical conditions for which the best treatment is a hysterectomy? In those cases, the primary goal of therapy is not to prevent pregnancy. Instead, sterility is an unfortunate side effect of a medically indicated treatment. Should that side effect preclude the provision of a therapy that is otherwise medically appropriate? We present a case that raises these issues, and asked experts in law, bioethics, community advocacy, and gynecology to respond. They discuss whether the best option is to proceed with the surgery or to cautiously delay making a decision to give the teenager more time to carefully consider all of the options.
View details for DOI 10.1542/peds.2016-3992
View details for PubMedID 28562274
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Compassionate Deactivation of Ventricular Assist Devices in Children: A Survey of Pediatric VAD Clinicians' Perspectives and Practices
ELSEVIER SCIENCE INC. 2017: S37–S38
View details for Web of Science ID 000398839800075
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Fairness and Transparency in an Expanded Access Program: Allocation of the Only Treatment for SMA1.
The American journal of bioethics : AJOB
2017; 17 (10): 71–73
View details for PubMedID 29020542
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Moral Distress in Clinical Ethics: Expanding the Concept
AMERICAN JOURNAL OF BIOETHICS
2016; 16 (12): 1-1
View details for DOI 10.1080/15265161.2016.1253963
View details for Web of Science ID 000390115900008
View details for PubMedID 27901425
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Randomized n-of-1 Trials: Quality Improvement, Research, or Both?
Pediatrics
2016; 138 (2)
Abstract
The regulatory demarcations between clinical research and quality improvement (QI) are ambiguous and controversial. Some projects that were undertaken as a form of QI were deemed by regulatory agencies to be research and thus to require institutional review board approval. In the era of personalized medicine, some physicians may ask some patients to participate in n-of-1 trials in an effort to personalize and optimize each patient's medical treatment. Should such activities be considered research, QI, or just excellent personalized medicine? Experts in research, research regulation, and bioethics analyze these issues.
View details for DOI 10.1542/peds.2016-1103
View details for PubMedID 27385811
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Current Use of Pelvic Organ Prolapse Quantification by AUGS and ICS Members
FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
2011; 17 (2): 67-69
Abstract
: To determine the current use of the pelvic organ prolapse quantification (POP-Q) by members of the American Urogynecologic Society (AUGS) and the International Continence Society (ICS).: Surgically active members of AUGS and ICS completed a Web-based questionnaire about their use of the POP-Q and included queries regarding respondent's clinical training, surgical experience, and practice setting. Users of POP-Q described their POP-Q use including patient's position, tools used to measure or assist with exposure, use of strain, and bladder volume. Strengths and weaknesses of the POP-Q system were also assessed.: The 308 respondents had a median of 8 years (range, 0-35 years) of independent performance of POP surgery. Most were from the United States (70%), in a shared practice (64%), with at least 2 years of fellowship training (61%), and had trainees participating in patient care (81%). Of the respondents, 76% reported using the POP-Q; however, the technique of POP-Q varied. Of the 24% not using the POP-Q, two-thirds reported past POP-Q use. For these individuals, prolapse description was done using Baden-Walker (57%), descriptive words (38%), or other grades (7%). More than 50% of nonusers reported that the POP-Q is "too time-consuming" or that their "colleagues do not use it.": Although most surveyed members of AUGS and ICS are using the POP-Q, we detected variability in the day-to-day practice of POP-Q use. To further advance the communication benefits of the POP-Q, a revision that provides evidence-based guidance may be a worthwhile refinement.
View details for DOI 10.1097/SPV.0b013e318207c904
View details for Web of Science ID 000209176100003
View details for PubMedID 22453690