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Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. University of Borås.ORCID iD: 0000-0001-7865-3480
University of Borås.
2011 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 4, 495-504 p.Article in journal (Refereed) Published
Abstract [en]

It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field.

Place, publisher, year, edition, pages
Sage Publications, 2011. Vol. 18, no 4, 495-504 p.
Keyword [en]
cardiopulmonary resuscitation, emergency medical services, end of life, ethics, futility, rituals
National Category
Nursing Ethics
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-16282DOI: 10.1177/0969733011404339OAI: oai:DiVA.org:lnu-16282DiVA: diva2:468805
Available from: 2011-12-21 Created: 2011-12-21 Last updated: 2017-05-03Bibliographically approved
In thesis
1. Vid existensens gräns: Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus
Open this publication in new window or tab >>Vid existensens gräns: Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
At the border of existence : Ethical caring and professional responsibility in the context of out-of-hospital cardiac arrests
Abstract [en]

Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems.

Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis.

Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families.

Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2012. 200 p.
Series
Linnaeus University Dissertations, 75/2012
Keyword
emergency medical services, ethical competence, ethics, out-of hospital cardiac arrest, lifeworld, phenomenology, professional responsibility, sudden cardiac death
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-16285 (URN)9789186983253 (ISBN)
Public defence
2012-01-27, Myrdal, Georg Lückligs väg 8, Växjö, 15:54 (Swedish)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-21 Last updated: 2017-05-03Bibliographically approved

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