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Cited by 71Ethics and bioethics in healthcarePalliative Care and End-of-Life IssuesEthics in medical practice

Ethical challenges in resuscitation

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Mentzelopoulos, Spyros D., Slowther, Anne-Marie, Fritz, Zoe, Sandroni, Claudio, Xanthos, Theodoros, Callaway, Clifton, Perkins, Gavin D., Newgard, Craig +4 more·2018·Intensive Care Medicine
DOI 10.1007/s00134-018-5202-0
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Abstract

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.

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  • Structured, complex, multifaceted interventions in the context of advance care planning and shared decision making may effectively prevent disproportionate/unwanted end-of-life care and accordingly reduce use of healthcare resources.

    “Structured, complex, multifaceted interventions in the context of advance care planning and shared decision making may effectively prevent disproportionate/unwanted end-of-life care and accordingly reduce use of healthcare resources. 4,7,44,72,355,398”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [72]

    The ACP section says complex interventions may reduce aggressive life-sustaining treatments and that linking patients’ wishes to care plans requires multifaceted approaches. It does not say these approaches reduce overall healthcare resource use; it describes the interventions themselves as resource-demanding. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Communication in the context of shared decision-making is associated with higher patient/family satisfaction and increased decisional confidence, as suggested by four systematic reviews.

    “Communication in the context of shared decision-making is associated with higher patient/ family satisfaction and increased decisional confidence, as suggested by four systematic reviews. 65,71,72,74”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [72]

    The ACP section (page unavailable) says advance care planning involves communication and shared decision-making, and that evidence suggests it promotes patient and/or family satisfaction. The copy does not report increased decisional confidence or attribute these outcomes to four systematic reviews. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Family support interventions may help reduce psychological impacts on family members, as suggested by four systematic reviews and two recent studies.

    “Family support interventions may help to reduce these psychological impacts, as suggested by four systematic reviews, 37,71,72,83 and two recent studies. 84,85”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [72]

    Table 4 (page unavailable) identifies psychological trauma to family members as an issue and says recent evidence supports family presence during resuscitation when caregivers skilled in family support are present. It does not explicitly say that family support interventions reduce psychological impacts, or identify the four systematic reviews and two studies described in the citing sentence. (LLM, conf=0.79)

    Experimental — accuracy not yet measured

  • The certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews.

    “Accordingly, the certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews. 7 10,28,38,39,43,44,72”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [72]

    The “Benefiting without harming” section says the evidence supporting neurological prognostication predictors after cardiac arrest is low or very low quality. It does not say that authors of systematic reviews most frequently rated the certainty of existing evidence this way across resuscitation research. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Mentzelopoulos, S. D., Slowther, A.-M., Fritz, Z., Sandroni, C., Xanthos, T., Callaway, C., Perkins, G. D., Newgard, C., Ischaki, E., Greif, R., Kompanje, E., & Bossaert, L.
Affiliations
  • National and Kapodistrian University of Athens (GR)
  • University of Warwick (GB)
  • Università Cattolica del Sacro Cuore (IT)
  • European University Cyprus (CY)
  • University of Pittsburgh (US)
  • Oregon Health & Science University (US)
  • University of Bern (CH)
  • Erasmus MC (NL)
  • University of Antwerp (BE)
Corresponding author
Mentzelopoulos, Spyros D.
ORCID
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
2018-05-10
Volume
44
Issue
6
Pages
703-716
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s00134-018-5202-0
OpenAlex
W2799560302
Cited by
71
References
0
Citations by year
2026: 6 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 9 · 2021: 14 · 2020: 10 · 2019: 4 · 2018: 3
FWCI
1.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Intensive Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • BORIS (University Library Bern) (submittedVersion, other-oa)
  • Open Access CRIS of the University of Bern
Funders
  • European Resuscitation Council
  • Università Cattolica del Sacro Cuore
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
Keywords
resuscitation ethics, bioethics, patient autonomy, beneficence and non-maleficence, human dignity, justice, family presence during resuscitation, emergency research, advance directives, shared decision-making, neurological outcome prediction, futility, life-sustaining treatment, resource allocation, evidence-based ethics
MeSH terms
Decision Making, Humans, Resuscitation, Medical Futility, Personal Autonomy, Beneficence

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