@article{2988161,
    title = "A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries",
    author = "Mentzelopoulos, S.D. and Bossaert, L. and Raffay, V. and Askitopoulou, H. and Perkins, G.D. and Greif, R. and Haywood, K. and Van de Voorde, P. and Xanthos, T.",
    journal = "Resuscitation",
    year = "2016",
    volume = "100",
    pages = "11-17",
    publisher = "Elsevier Ireland Ltd",
    issn = "0300-9572",
    doi = "10.1016/j.resuscitation.2015.12.010",
    keywords = "Article;  Austria;  Belgium;  bioethics;  Bosnia and Herzegovina;  consensus development;  Croatia;  Cyprus;  Czech Republic;  Denmark;  Finland;  France;  Germany;  human;  Hungary;  Iceland;  Italy;  leadership;  Luxembourg;  Malta;  medical society;  Netherlands;  Norway;  Poland;  priority journal;  resuscitation;  Romania;  Russian Federation;  Serbia;  Slovakia;  Slovenia;  Spain;  Sweden;  Switzerland;  Turkey (republic);  United Kingdom;  adult;  child;  ethics;  Europe;  female;  heart arrest;  leadership;  male;  medical ethics;  preschool child;  questionnaire;  resuscitation;  statistical model;  terminal care, Adult;  Cardiopulmonary Resuscitation;  Child;  Child, Preschool;  Ethics, Medical;  Europe;  Female;  Heart Arrest;  Humans;  Leadership;  Linear Models;  Male;  Surveys and Questionnaires;  Terminal Care",
    abstract = "Background: Europe is a patchwork of 47 countries with legal, cultural, religious, and economic differences. A prior study suggested variation in ethical resuscitation/end-of-life practices across Europe. This study aimed to determine whether this variation has evolved, and whether the application of ethical practices is associated with emergency care organisation. Methods: A questionnaire covering four domains of resuscitation ethics was developed based on consensus: (A) Approaches to end-of-life care and family presence during cardiopulmonary resuscitation; (B) Determinants of access to best resuscitation and post-resuscitation care; (C) Diagnosis of death and organ donation (D) Emergency care organisation. The questionnaire was sent to representatives of 32 countries. Responses to 4-choice or 2-choice questions pertained to local legislation and common practice. Positive responses were graded by 1 and negative responses by 0; grades were reconfirmed/corrected by respondents from 31/32 countries (97%). For each resuscitation/end-of-life practice a subcomponent score was calculated by grades' summation. Subcomponent scores' summation resulted in domain total scores. Results: Data from 31 countries were analysed. Domains A, B, and D total scores exhibited substantial variation (respective total score ranges, 1-41, 0-19 and 9-32), suggesting variable interpretation and application of bioethical principles, and particularly of autonomy. Linear regression revealed a significant association between domain A and D total scores (adjusted r2 = 0.42, P < 0.001). Conclusions: According to key experts, ethical practices and emergency care still vary across Europe. There is need for harmonised legislation, and improved, education-based interpretation/application of bioethical principles. Better application of ethical practices may be associated with improved emergency care organisation. © 2016 Elsevier Ireland Ltd."
}