Ethical issues06122011
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This document discusses the ethical issues surrounding cardiopulmonary resuscitation (CPR). It outlines key ethical principles like autonomy, beneficence, non-maleficence, justice, dignity and honesty. It discusses when CPR may be withheld or withdrawn based on these principles and medical futility. Factors like advanced directives, surrogate decision makers, signs of death, drug intoxication and hypothermia are considered for initiating or stopping CPR. The document provides guidance on ethical decision making around CPR.
Ethical issues06122011
- 1. ETHICAL ISSUES in Cardiopulmonary Resuscitation ALS Subcommittee 2010
- 2. Ethical issues • CPR is a therapy • KEY principles of ethics include: - autonomy - beneficence - non maleficence - justice - dignity and honesty • Withholding and withdrawal therapy ALS Subcommittee 2010
- 3. Ethical principles – Patient Autonomy • Recognized ethically and legally • Right of patient to accept or refuse treatment • Applied to those capable of making decision • Decision based on understanding of disease, patient condition, nature of treatment, alternative therapy, risks and benefits ALS Subcommittee 2010
- 4. Ethical principles – Beneficence Benefit provided to patient while balancing risks and benefits Are we providing benefit to patient or are we just delaying death and prolonging suffering? ALS Subcommittee 2010
- 5. Ethical principles – Non-maleficence Do no harm, or further harm - CPR should not be initiated in futile cases ALS Subcommittee 2010
- 6. Ethical principles – Justice Duty to distribute limited health resources equally within a society, and the decision of who gets what treatment If resuscitation is provided, it should be available to all who will benefit from it within the available resources ALS Subcommittee 2010
- 7. Ethical principles – Dignity and Honesty Patient’s right to be treated with dignity Honesty in revealing information ALS Subcommittee 2010
- 8. Ethical principles Advanced directives • ‘Living will’, wishes or expression for end of life care • Based on conversational or written directives • Periodic consideration needed as patient’s desire and condition may change ALS Subcommittee 2010
- 9. Ethical principles Surrogate decision maker • ‘Nominated’ decision maker when patient is incapable of making one • Spouse, adult child, parent, close relative • ? friend ALS Subcommittee 2010
- 10. MEDICAL FUTILITY • When an intervention is highly unlikely to benefit the patient or • When an intervention does not achieve patient’s intended quality goals or physician’s physiological goals • Key determinants - Length - Quality of life ALS Subcommittee 2010
- 11. PRINCIPLE OF FUTILITY • Withholding resuscitation and discontinuation of life-sustaining treatment during or after resuscitation are ethically equivalent • If the prognosis is uncertain, a trial of treatment should be considered while further information is gathered to help determine the likelihood of survival and expected clinical course ALS Subcommittee 2010
- 12. When Not to Start CPR • Advanced directives by patient or surrogate decision maker • Valid DNAR by attending physician • Obvious signs of death e.g. Rigor mortis • Algo mortis - steady lowering temperature • Injuries incompatible with life ALS Subcommittee 2010
- 13. When NOT to Stop • Drug intoxication • Hypothermia • Ventricular fibrillation ALS Subcommittee 2010
- 14. When to Stop CPR • Return of spontaneous circulation (ROSC) • Too exhausted to continue, or dangerous • Obvious signs of death are apparent • Decision to cease resuscitation effort are often made on a case to case basis ALS Subcommittee 2010
- 15. THANK YOU NATIONAL COMMITTEE ON RESUSCITATION TRAINING SUBCOMMITEE FOR ADVANCED LIFE SUPPORT Dr Tan Cheng Cheng Dr Luah Lean Wah Dr Ismail Tan Dr Wan Nasrudin Dr Chong Yoon Sin Dr Priya Gill Dr Ridzuan bin Dato’ Mohd Isa Dr Thohiroh Abdul Razak Dr Adi Osman ALS Subcommittee 2010