The ethics panel of the American Heart Association recommended that ethical values, including patient autonomy and provider advocacy, should guide the provision of advanced cardiac life support (ACLS) and emergency cardiac care (ECC). The panel developed guidelines regarding the institution and withdrawal of basic life support, ACLS, and the criteria for the determination of death. A discussion of futility, No-CPR orders, living wills, advance directives, and their impact on E0C is included.
[Crimmins T J: Ethical issues in adult resuscitation. Ann Emerg Med February 1993;22 (pt 2):495-501 .]
OVERVIEW OF ISSUES
Earlier medicolegal guidelines developed by the American Heart Association (AHA) discuss legal liability resulting from the provision of advanced cardiac life support (ACLS). 1 The 1992 conference panel on ethical issues in adult resuscitation and audience participants agreed that ethical considerations should direct decision making when CPR is initiated or withdrawn. Panelists agreed that the new guidelines should be based on the values that guide the provision of all medical therapies: to preserve life, maintain and restore health, limit disability, and relieve pain and suffering. These medical values should be considered in a context of the societal values of autonomy, beneficence, and justice. Although medical decision making should be based On principles of ethics, this does not eliminate legal liability in the provision of CPR. Differences of opinion remained among conference participants regarding the application of these values in medical decision making when initiating and withdrawing life support. The panel concluded that ethical values and legal mandates, not the threat of malpractice, should form the basis for the new AHA guidelines for the provision of ACLS and emergency cardiac care (ECC).
Values in Decision
Making Patient autonomy has become a dominant value in medical decision making. A competent and informed individual has a moral right to consent FEBRUARY 1993 22:2 PART 2 ANNALS OF EMERGENCY MEDICINE