Part 2: Ethical Issues

Abstract

The goals of emergency cardiovascular care are to preserve life, restore health, relieve suffering, limit disability, and reverse clinical death. CPR decisions are often made in seconds by rescuers who may not know the patient or know if an advance directive exists. As a result, administration of CPR may sometimes conflict with a patient’s desires or best interests.1 This section provides guidelines to healthcare providers for making the difficult decision to provide or withhold emergency cardiovascular care. Ethical and cultural norms must be considered when beginning and ending a resuscitation attempt. Although physicians must play a role in resuscitation decision making, they should be guided by scientifically proven data and patient preferences. ### Principle of Patient Autonomy Patient autonomy is generally respected both ethically and legally. It assumes that a patient can understand what an intervention involves and consent to or refuse it. Adult patients are presumed to have decision-making capability unless they are incapacitated or declared incompetent by a court of law. Truly informed decisions require that patients receive and understand accurate information about their condition and prognosis, the nature of the proposed intervention, alternatives, and risks and benefits. The patient must be able to deliberate and choose among alternatives and be able to relate the decision to a stable framework of values. When decision-making capacity is temporarily impaired by factors such as concurrent illness, medications, or depression, treatment of these conditions may restore capacity. When patient preferences are uncertain, emergency conditions should be treated until those preferences can be clarified. #### Advance Directives, Living Wills, and Patient Self-Determination An advance directive is any expression of a person’s thoughts, wishes, or preferences for his or her end-of-life care. Advance directives can be based on conversations, written directives, living wills, or durable powers of attorney for health care. The legal validity of various forms of advance directives varies from jurisdiction to jurisdiction. …