Ethical challenges in resuscitation

Claudio Sandroni, Spyros D. Mentzelopoulos, Anne-Marie Slowther, Zoe Fritz, Theodoros Xanthos, Clifton Callaway, Gavin D. Perkins, Craig Newgard, Eleni Ischaki, Robert Greif, Erwin Kompanje, Leo Bossaert

Risultato della ricerca: Contributo in rivistaArticolo in rivista

19 Citazioni (Scopus)

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.
Lingua originaleEnglish
pagine (da-a)703-716
Numero di pagine14
RivistaIntensive Care Medicine
Volume44
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Beneficence
  • Critical Care and Intensive Care Medicine
  • Decision Making
  • Humans
  • Medical Futility
  • Personal Autonomy
  • Personal autonomy
  • Resuscitation
  • Social justice

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