Ethics in treatment decisions during out-of-hospital resuscitation

Pre‐hospital cardiac arrest and induction of mild hypothermia: studies on epidemiology and feasibility

“…Withholding resuscitation in a victim of sudden cardiac arrest embraces aspects related to ethical, medical, legal and economical issues (Naess et al 1997;Naess and Steen 2004;Pawl 2007;Suchard et al 1999). Especially ethical standpoints are prone to subjectivity (Baskett and Lim 2004) that can and need not to be dictated on scientific basis only (Baskett et al 2007;Baskett and Lim 2004).…”

“…The same does not necessarily apply to the prehospital setting (Naess et al 1997). Some EMS systems have no online medical direction and the decision whether to resuscitate or not is ultimately left to be made by paramedics or emergency medical technicians (Baskett et al 2007;Weston et al 1995).…”

“…Although prehospital physicians and paramedics have been observed to conduct endof-life decision-making on similar bases (Naess et al 1997), the general recommendation is that a physician should be consulted and among physicians consensus be sought when resuscitation is considered to be withheld (Baskett et al 2007;ERC 2005;Ferrand et al 2006). Optimally, the preferred course of treatment would be discussed with the patient prior to critical illness -90 % of non-critically ill patients would prefer being asked their perception regarding a DNAR-order (Gorton et al 2008).…”

“…2004). Although the costs of resuscitation per life year gained are comparable to or less than most life saving or intensive medical interventions (Karlsson et al 2009;Naess and Steen 2004;Tengs et al 1995) it has been shown that these issues do not influence decision-making in the prehospital setting (Ferrand et al 2006;Naess et al 1997).…”

“…This decision is equally demanding to the decision whether to initiate resuscitation in the first place (Baskett et al 2007;Naess et al 1997). However, certain rules for prehospital termination of resuscitation (TOR) have been developed based on criteria which have been prognostic of futility (Bonnin et al 1993;Morrison et al 2007).…”