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:
The authors are grateful to Prof. Antonio G. Spagnolo, Director of the Institute of Bioethics and Medical Humanities Università Cattolica del Sacro Cuore, Rome, Italy, for offering useful advice during manuscript preparation. The authors acknowledge the support of the European Resuscitation Council for the conduct of teleconferences.
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 -