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To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department

Emergency physicians (EPs) working in low-resource settings, where patients mainly bear the cost of healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusse...

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Autores principales: Kumar, Nirdosh, Fatima, Meraj, Ghaffar, Sara, Subhani, Faysal, Waheed, Shahan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Emergency Medicine 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350361/
https://www.ncbi.nlm.nih.gov/pubmed/37188357
http://dx.doi.org/10.15441/ceem.23.027
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author Kumar, Nirdosh
Fatima, Meraj
Ghaffar, Sara
Subhani, Faysal
Waheed, Shahan
author_facet Kumar, Nirdosh
Fatima, Meraj
Ghaffar, Sara
Subhani, Faysal
Waheed, Shahan
author_sort Kumar, Nirdosh
collection PubMed
description Emergency physicians (EPs) working in low-resource settings, where patients mainly bear the cost of healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusses some of the common bioethical issues in the resuscitation and postresuscitation phases of treatment. Solutions are proposed and the necessity for evidence-based ethics and unanimity on ethical standards is emphasized. After a consensus was reached on the structure of the article, smaller groups of authors (2–3) wrote narrative reviews of ethical issues such as patient autonomy and honesty, beneficence and nonmaleficence, dignity, justice, and specific practices and circumstances such as family presence during resuscitation after discussions with senior EPs. Ethical dilemmas were discussed, and solutions were proposed. Cases related to medical decision-making by proxy, financial constraints in management, and resuscitation in the face of medical futility have been discussed. Solutions proposed include the early-stage involvement of hospital ethics committees, financial assurance in place beforehand, and allowing some leverage on a case-to-case basis when care is futile. We recommend developing evidence-based national ethical guidelines and incorporating societal and cultural norms with autonomy, beneficence, nonmaleficence, honesty, and justice principles.
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spelling pubmed-103503612023-07-18 To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department Kumar, Nirdosh Fatima, Meraj Ghaffar, Sara Subhani, Faysal Waheed, Shahan Clin Exp Emerg Med Review Article Emergency physicians (EPs) working in low-resource settings, where patients mainly bear the cost of healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusses some of the common bioethical issues in the resuscitation and postresuscitation phases of treatment. Solutions are proposed and the necessity for evidence-based ethics and unanimity on ethical standards is emphasized. After a consensus was reached on the structure of the article, smaller groups of authors (2–3) wrote narrative reviews of ethical issues such as patient autonomy and honesty, beneficence and nonmaleficence, dignity, justice, and specific practices and circumstances such as family presence during resuscitation after discussions with senior EPs. Ethical dilemmas were discussed, and solutions were proposed. Cases related to medical decision-making by proxy, financial constraints in management, and resuscitation in the face of medical futility have been discussed. Solutions proposed include the early-stage involvement of hospital ethics committees, financial assurance in place beforehand, and allowing some leverage on a case-to-case basis when care is futile. We recommend developing evidence-based national ethical guidelines and incorporating societal and cultural norms with autonomy, beneficence, nonmaleficence, honesty, and justice principles. The Korean Society of Emergency Medicine 2023-05-15 /pmc/articles/PMC10350361/ /pubmed/37188357 http://dx.doi.org/10.15441/ceem.23.027 Text en Copyright © 2023 The Korean Society of Emergency Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ).
spellingShingle Review Article
Kumar, Nirdosh
Fatima, Meraj
Ghaffar, Sara
Subhani, Faysal
Waheed, Shahan
To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
title To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
title_full To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
title_fullStr To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
title_full_unstemmed To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
title_short To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
title_sort to resuscitate or not to resuscitate? the crossroads of ethical decision-making in resuscitation in the emergency department
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350361/
https://www.ncbi.nlm.nih.gov/pubmed/37188357
http://dx.doi.org/10.15441/ceem.23.027
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