The ethics of resuscitation and end of life decisions

Introduction: Successful resuscitation attempts have brought extended, useful, and precious life to many, and happiness and relief to their relatives and loved ones. And yet there are occasions when resuscitation attempts have merely prolonged suffering and the process of dying. In a few cases, resuscitation has resulted in the ultimate tragedy - the patient in a persistent vegetative state. It is to be remembered that resuscitation attempts are unsuccessful in 70%-95% of cases and death ultimately is inevitable. All would wish to die with dignity. A number of ethical decisions are required to ensure that the decisions to attempt or withhold resuscitation are appropriate and the patients and their loved ones are treated with dignity. These decisions may be influenced by individual, international, and local cultural, legal, traditional, religious, social and economic factors. Sometimes the decisions can be made in advance, but often they have to be made in a matter of seconds at the time of the emergency. Therefore, it is important that healthcare providers understand the principles involved before they are put in a situation where a resuscitation decision must be made. This chapter will deal with the following ethical aspects and decisions: Advance directives, sometimes known as Living Wills. When not to start resuscitation attempts. When to stop resuscitation attempts. Decision making by non-physicians. When to withdraw treatment in those in a persistent vegetative state following resuscitation.