ETHICAL ISSUES OF CARDIOPULMONARY-RESUSCITATION - CURRENT PRACTICE AMONG EMERGENCY PHYSICIANS

Objective: To determine current practice and attitudes among emergency physicians (EPs) regarding the initiation and termination of CPR. Met hods: An anonymous survey was mailed to randomly selected EPs. Main ou tcome measures included respondents' answers to questions regarding ou tcome of resuscitation, and current practice regarding initiation, con tinuation, and termination of resuscitation for victims of cardiopulmo nary arrest. Results: The 1,252 respondents were from all 50 states, a variety of practice settings, and varying board certification. Most ( 78%) respondents honor legal advance directives regarding resuscitatio n. Few (7%) follow unofficial documents, or verbal reports of advance directives (6%). Many (62%) make decisions regarding resuscitation bec ause of fear of litigation or criticism. A majority (55%) have recentl y attempted numerous resuscitations despite expectations that such eff orts would be futile. Most respondents indicated that ideally, legal c oncerns should not influence physician practice regarding resuscitatio n (78%), but that in the current environment, legal concerns do influe nce practice (94%). Conclusions: Most EPs attempt to resuscitate patie nts in cardiopulmonary arrest, regardless of futility, except in cases where a legal advance directive is available. Many EPs' decisions reg arding resuscitation are based on concerns of litigation and criticism , rather than their professional judgment of medical benefit or futili ty. Compliance with patients' wishes regarding resuscitation is low un less a legal advance directive is present. Possible solutions to these problems may include standardized guidelines for the initiation and t ermination of CPR, tort reform, and additional public education regard ing resuscitation and advance directives. Key words: resuscitation; et hics; survey; CPR; cardiopulmonary resuscitation; futility.