Περίληψη:
Purpose: A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation. Methods: Following agreement on the article’s outline, subgroups of 2–3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered. Results: Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals’ education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased. Conclusions: Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
Συγγραφείς:
Mentzelopoulos, S.D.
Slowther, A.-M.
Fritz, Z.
Sandroni, C.
Xanthos, T.
Callaway, C.
Perkins, G.D.
Newgard, C.
Ischaki, E.
Greif, R.
Kompanje, E.
Bossaert, L.
Λέξεις-κλειδιά:
adult; article; beneficence; comorbidity; education; emergency; ethnicity; funding; honesty; human; human dignity; life sustaining treatment; living will; narrative; outcome assessment; patient autonomy; patient-reported outcome; personal autonomy; race; resuscitation; shared decision making; social justice; beneficence; decision making; personal autonomy; treatment outcome, Beneficence; Decision Making; Humans; Medical Futility; Personal Autonomy; Resuscitation
