Rib histology after unsuccessful cardiopulmonary resuscitation in infants suffering sudden death from natural causes; implications for injury mechanism and timing

Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis

Nursing Ethics ◽

10.1177/0969733011404339 ◽

2011 ◽

Vol 18 (4) ◽

pp. 495-504 ◽

Cited By ~ 16

Author(s):

Anders Bremer ◽

Lars Sandman

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Sudden Death ◽

Ethical Problem ◽

Significant Others ◽

Ethical Analysis ◽

Prehospital Emergency Care ◽

Moral Reasons ◽

Care Needs ◽

Prehospital Emergency

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.

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Unexpected and sudden death from natural causes

Simpson's Forensic Medicine, 13th Edition ◽

10.1201/b13324-7 ◽

2011 ◽

pp. 54-64

Keyword(s):

Sudden Death ◽

Death From Natural Causes

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Mechanical Cardiopulmonary Resuscitation Choice of Patients on Chronic Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089001000411 ◽

1990 ◽

Vol 10 (4) ◽

pp. 299-302 ◽

Cited By ~ 2

Author(s):

Antonios H. Tzamaloukas ◽

Phillip G. Zager ◽

Barbara J. Quintana ◽

Marie Nevarez ◽

Kathleen Rogers ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cardiopulmonary Resuscitation ◽

Sudden Death ◽

Chest Wall ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Flail Chest ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

Multiple Rib Fractures ◽

Chest Wall Trauma

Fifty-five adult patients (5 women, 50 men) on chronic peritoneal dialysis, mostly continuous ambulatory peritoneal dialysis (CAPD), for 2 to 155 mon were asked whether or not they wanted to have mechanical cardiopulmonary resuscitation (CPR) in case of sudden death. Thirty-five patients (65%) opted for CPR and 20 (36%) declined. Statistically, sex (although the number of women interviewed was too small for a valid sample) and duration of dialysis had no effect on choice of CPR, whereas older age, the presence of diabetes, advanced medical disability, and advanced socioeconomic disability were associated with a tendency to decline CPR. Among the 10 patients who had CPR, 5 developed flail chest, 4 had multiple rib fractures, and only 1 had no chest wall trauma from CPR. Two patients left the hospital alive. One third of the patients on chronic peritoneal dialysis do not want CPR. Advanced age, diabetes, and poor medical and socioeconomic states predispose peritoneal dialysis patients to decline CPR.

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