[The ethics of resuscitation].

Abstract

Resuscitation should always be attempted in a patient who has at least a theoretical chance of survival. This assumes that there are patent cerebral, coronary and pulmonary vessels, a reasonable time from cardiac arrest has not been exceeded, and cardiac arrest did not occur as a result of a terminal condition caused by an untreatable disease. During resuscitation, medical personnel may face two dilemmas: when to start CPR, and when (and how) to stop it. Apart from various medical conditions, possible outcome and will of a victim has to be taken into consideration. CPR is frequently started without an adequate knowledge of the patient's medical status. As soon as the latter is obtained, a decision about continuing CPR should be reconsidered. CPR and/or life-prolonging treatment can be stopped in several situations, i.e. lack of cardiovascular response or recognition of a life-limiting condition. The decision should be made by a team leader, acting in accordance with national or house guidelines. In terminal patients, a DNR order should be issued well in advance, usually by an attending physician. After that, the patient should be provided with palliative care, consisting of pain therapy, and treatment of dyspnoea, congestive cardiac failure, etc. In their review, the authors discuss various medical and ethical aspects of resuscitation, concluding that hospital ethics committees could be of great value in solving complicated questions relating to limitation of resuscitation and life-prolonging treatment.