BACKGROUND: In recent years, an unprecedented expansion of high-tech medical knowledge has forced anesthesiologists to confront a moral climate never experienced before, thereby escalating the need to refer to ethical resources for the appropriate responses. This study was prepared to identify the issues and to determine the extent of activities in making proper ethical decisions regarding anesthesia around the world. METHODS: Eighteen questions were asked via electronic mail to anestheisa-associated doctors recognized by the Internet between April and June 1998. Information about issues, guidelines/standards/policy, consulting system/committee, education and training were requested. RESULTS: One hundred and twenty-two practitioners completed the questionnaire. Informed consent (38, 31.1%) was the most frequently raised issue, followed by medical economics (13.1%) and DNR (11.5%). The most serious broad issue was medical economics (13.1%), but specific or unique issues were not prominent. Among respondents, 73.8% had no guideline/standards/policy in their department, 56.6% felt the need to have one, 38.5% had one in the hospital and 51.6% indicated they needed one in their hospital. Most departments had no consulting system (61.5%) or committee (79.5%), while 48.4% had no consulting system and 63.9% had no committee in the hospital. A few (28, 23.1%) had a program/ curriculum, and lectures were the most common format. The most common duration of ethical education was more than 3 hours and the main obstacle was time constraints. Informed consent (41.8%) was indicated as the most important issue to be taught. CONCLUSIONS: A limited number favored systemic support and the educational benefit of lectures on ethics. Most respondents were willing to have such a lecture program in the department. Establishing a systemic structure for ethics was recommended by most respondents and restricted resources should be distributed for this purpose according to the survey results.