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Ethical issues

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This document discusses the key ethical issues surrounding cardiopulmonary resuscitation (CPR). It outlines five main ethical principles - autonomy, beneficence, non-maleficence, justice, and dignity/honesty. It also discusses concepts like medical futility, advanced directives, surrogate decision makers, and guidelines for when to start or stop CPR based on patient conditions and prognosis. The document is intended to provide an overview of the ethical considerations in CPR for medical training purposes.

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ETHICAL ISSUES in Cardiopulmonary Resuscitation
Ethical issues CPR is a therapy KEY principles of ethics include: - autonomy - beneficence - non maleficence - justice - dignity and honesty Withholding and withdrawal therapy
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
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?
Ethical principles Non-maleficence Do no harm, or further harm - CPR should not be initiated in futile cases
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
Ethical principles Dignity and Honesty Patients right to be treated with dignity Honesty in revealing information
Ethical principles Advanced directives Living will, wishes or expression for end of life care Based on conversational or written directives Periodic consideration needed as patients desire and condition may change
Ethical principles Surrogate decision maker Nominated decision maker when patient is incapable of making one Spouse, adult child, parent, close relative ? friend
MEDICAL FUTILITY When an intervention is highly unlikely to benefit the patient or When an intervention does not achieve patients intended quality goals or physicians physiological goals Key determinants - Length - Quality of life
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
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
When NOT to Stop Drug intoxication Hypothermia Ventricular fibrillation
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
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

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Ethical issues

  • 2. Ethical issues CPR is a therapy KEY principles of ethics include: - autonomy - beneficence - non maleficence - justice - dignity and honesty Withholding and withdrawal therapy
  • 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
  • 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?
  • 5. Ethical principles Non-maleficence Do no harm, or further harm - CPR should not be initiated in futile cases
  • 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
  • 7. Ethical principles Dignity and Honesty Patients right to be treated with dignity Honesty in revealing information
  • 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 patients desire and condition may change
  • 9. Ethical principles Surrogate decision maker Nominated decision maker when patient is incapable of making one Spouse, adult child, parent, close relative ? friend
  • 10. MEDICAL FUTILITY When an intervention is highly unlikely to benefit the patient or When an intervention does not achieve patients intended quality goals or physicians physiological goals Key determinants - Length - Quality of life
  • 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
  • 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
  • 13. When NOT to Stop Drug intoxication Hypothermia Ventricular fibrillation
  • 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
  • 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