Ethical issues06122011


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Ethical issues06122011

  1. 1. ETHICAL ISSUES inCardiopulmonary Resuscitation ALS Subcommittee 2010
  2. 2. Ethical issues• CPR is a therapy• KEY principles of ethics include: - autonomy - beneficence - non maleficence - justice - dignity and honesty• Withholding and withdrawal therapy ALS Subcommittee 2010
  3. 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 ALS Subcommittee 2010
  4. 4. Ethical principles – BeneficenceBenefit provided to patient while balancing risksand benefits Are we providing benefit to patient or are we just delaying death and prolonging suffering? ALS Subcommittee 2010
  5. 5. Ethical principles – Non-maleficenceDo no harm, or further harm - CPR should not be initiated in futile cases ALS Subcommittee 2010
  6. 6. Ethical principles – JusticeDuty to distribute limited health resourcesequally within a society, and the decision of whogets what treatmentIf resuscitation is provided, it should be availableto all who will benefit from it within the availableresources ALS Subcommittee 2010
  7. 7. Ethical principles – Dignity and HonestyPatient’s right to be treated with dignityHonesty in revealing information ALS Subcommittee 2010
  8. 8. Ethical principlesAdvanced directives• ‘Living will’, wishes or expression for end of life care• Based on conversational or written directives• Periodic consideration needed as patient’s desire and condition may change ALS Subcommittee 2010
  9. 9. Ethical principlesSurrogate decision maker• ‘Nominated’ decision maker when patient is incapable of making one• Spouse, adult child, parent, close relative• ? friend ALS Subcommittee 2010
  10. 10. MEDICAL FUTILITY• When an intervention is highly unlikely to benefit the patient or• When an intervention does not achieve patient’s intended quality goals or physician’s physiological goals• Key determinants - Length - Quality of life ALS Subcommittee 2010
  11. 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 ALS Subcommittee 2010
  12. 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 ALS Subcommittee 2010
  13. 13. When NOT to Stop• Drug intoxication• Hypothermia• Ventricular fibrillation ALS Subcommittee 2010
  14. 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 ALS Subcommittee 2010
  15. 15. THANK YOUNATIONAL 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 ALS Subcommittee 2010