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Ethical challenges in resuscitation
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Mentzelopoulos, Spyros D., Slowther, Anne, Fritz, Zoe, Sandroni, Claudio, Xanthos, Theodoros, Callaway, Clifton W., Perkins, Gavin D., Newgard, Craig, Ischaki, Eleni, Greif, Robert, Kompanje, Erwin and Bossaert, Leo (2018) Ethical challenges in resuscitation. Intensive Care Medicine, 44 (6). pp. 703-716. doi:10.1007/s00134-018-5202-0
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WRAP-ethical-challenges-resuscitation-Perkins-2018.pdf - Accepted Version - Requires a PDF viewer. Download (953Kb) | Preview |
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Official URL: http://dx.doi.org/10.1007/s00134-018-5202-0
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.
Item Type: | Journal Item | ||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Resuscitation, Cardiac resuscitation, Cardiac resuscitation -- Moral and ethical aspects | ||||||||
Journal or Publication Title: | Intensive Care Medicine | ||||||||
Publisher: | Springer-Verlag | ||||||||
ISSN: | 0342-4642 | ||||||||
Official Date: | June 2018 | ||||||||
Dates: |
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Volume: | 44 | ||||||||
Number: | 6 | ||||||||
Page Range: | pp. 703-716 | ||||||||
DOI: | 10.1007/s00134-018-5202-0 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 30 July 2018 | ||||||||
Date of first compliant Open Access: | 10 May 2019 | ||||||||
RIOXX Funder/Project Grant: |
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