A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries
Open accessAbstract
Background Europe is a patchwork of 47 countries with legal, cultural, religious, and economic differences. A prior study suggested variation in ethical resuscitation/end-of-life practices across Europe. This study aimed to determine whether this variation has evolved, and whether the application of ethical practices is associated with emergency care organisation. Methods A questionnaire covering four domains of resuscitation ethics was developed based on consensus: (A) Approaches to end-of-life care and family presence during cardiopulmonary resuscitation; (B) Determinants of access to best resuscitation and post-resuscitation care; (C) Diagnosis of death and organ donation (D) Emergency care organisation. The questionnaire was sent to representatives of 32 countries. Responses to 4-choice or 2-choice questions pertained to local legislation and common practice. Positive responses were graded by 1 and negative responses by 0; grades were reconfirmed/corrected by respondents from 31/32 countries (97%). For each resuscitation/end-of-life practice a subcomponent score was calculated by grades' summation. Subcomponent scores' summation resulted in domain total scores. Results Data from 31 countries were analysed. Domains A, B, and D total scores exhibited substantial variation (respective total score ranges, 1-41, 0-19 and 9-32), suggesting variable interpretation and application of bioethical principles, and particularly of autonomy. Linear regression revealed a significant association between domain A and D total scores (adjusted r(2)=0.42, P<0.001). Conclusions According to key experts, ethical practices and emergency care still vary across Europe. There is need for harmonised legislation, and improved, education-based interpretation/application of bioethical principles. Better application of ethical practices may be associated with improved emergency care organisation.
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Generalisability outside of Karolinska University Hospital is limited, as the use of DNACPR decisions is influenced by cultural, religious, and legal factors, as well as regional and institutional policies.
“Generalisability outside of Karolinska University Hospital is limited, as the use of DNACPR decisions is influenced by cultural, religious, and legal factors, as well as regional, and institutional policies.23., 24., 38., 39.”
From Do-Not-Attempt-Cardiopulmonary-Resuscitation (DNACPR) decisions in patients admitted through the emergency department in a Swedish University Hospital – An observational study of outcome, patient characteristics and changes in DNACPR decisions (2022) · cites this paper as [38]
The Discussion says interpretations of autonomy may vary with religion and culture and describes differing legal approaches to resuscitation decisions. Domain A (Table 3) reports variation across countries in the legal recognition and use of DNAR orders. The paper does not establish that regional or institutional policies influence DNACPR decisions; the limitation on generalisability from Karolinska is the citing authors’ inference. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAnother ethically acceptable and legally supported consent model comprises exception to informed consent (EIC) with prior community consultation (and a possibility of prospective opt out for community members).
“Another ethically acceptable and legally supported consent model comprises exception to informed consent (EIC) with prior community consultation (and a possibility of prospective opt out for community members). 328 335”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [328]
The Discussion (page unavailable) mentions an EU regulation addressing ethical principles in emergency research involving incapacitated patients, but does not describe exception to informed consent as a consent model. Searches for community consultation and prospective opt-out found no supporting passage in our copy. (LLM, conf=0.73)
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- Authors
- Mentzelopoulos, S. D., Bossaert, L., Raffay, V., Askitopoulou, H., Perkins, G. D., Greif, R., Haywood, K., Van de Voorde, P., & Xanthos, T.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- University of Antwerp (BE)
- University of Crete (GR)
- Heart of England NHS Foundation Trust (GB)
- University of Bern (CH)
- Royal College of Nursing (GB)
- Midwestern University (US)
- Corresponding author
- Mentzelopoulos, Spyros D.
- ORCID
- Venue
- Resuscitation
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 100
- Pages
- 11-17
- ISSN
- 0300-9572 (ISSN-L)
- OpenAlex
- W2269502375
- Cited by
- 48
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 7 · 2017: 8 · 2016: 4 · 2015: 2
- FWCI
- 7.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Resuscitation (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Funders
- European Resuscitation Council
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- resuscitation ethics, cardiopulmonary resuscitation, end-of-life care, family presence during resuscitation, death determination, organ donation, bioethical principles, autonomy, cross-national variation, European countries, expert opinion
- MeSH terms
- Adult, Child, Child, Preschool, Ethics, Medical, Europe, Female, Heart Arrest, Humans, Leadership, Male, Surveys and Questionnaires, Terminal Care, Linear Models, Cardiopulmonary Resuscitation
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