TY - JOUR
T1 - Ethical challenges in resuscitation
AU - Mentzelopoulos, Spyros D.
AU - Slowther, Anne Marie
AU - Fritz, Zoe
AU - Sandroni, Claudio
AU - Xanthos, Theodoros
AU - Callaway, Clifton
AU - Perkins, Gavin D.
AU - Newgard, Craig
AU - Ischaki, Eleni
AU - Greif, Robert
AU - Kompanje, Erwin
AU - Bossaert, Leo
N1 - Funding Information:
Gavin Perkins has received research funding from the National Institute for Health Research to conduct studies in cardiac arrest; he holds volunteer roles within the Resuscitation Council (UK), European Resuscitation Council and International Liaison Committee on Resuscitation. Leo Bossaert holds volunteer roles within the European Resuscitation Council. Robert Greif holds a volunteer role within the European Resuscitation Council and International Liaison Committee on Resuscitation. No other author has a conflict of interest to disclose.
Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Purpose: A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation. Methods: Following agreement on the article’s outline, subgroups of 2–3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered. Results: Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals’ education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased. Conclusions: Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research.
AB - Purpose: A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation. Methods: Following agreement on the article’s outline, subgroups of 2–3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered. Results: Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals’ education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased. Conclusions: Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research.
KW - Beneficence
KW - Personal autonomy
KW - Resuscitation
KW - Social justice
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U2 - 10.1007/s00134-018-5202-0
DO - 10.1007/s00134-018-5202-0
M3 - Review article
C2 - 29748717
AN - SCOPUS:85046762560
VL - 44
SP - 703
EP - 716
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 6
ER -