PMID: 9542032May 23, 1998Paper

Ethical challenges in preclinical emergency medicine

Zentralblatt für Chirurgie
M Mohr, D Kettler

Abstract

Out-of-hospital emergency medicine, just like any other medical field, must be guided by general ethical principles of medical action. These include respecting the patient's autonomous decision, acting for his benefit, avoiding harm, and justice in distributing the available means. The confrontation with ethical conflicts in the routine of emergency medicine is illustrated by a case report. The emergency physician, called to a 76-year-old patient with circulatory arrest, decides against starting a resuscitation attempt. His decision is based on the fact that at least 15 minutes had passed from the cardiac arrest till the arrival of the emergency care team, on the previously existing, severe cardiac disease, on the age of the patient, on family statements of patient's refusal of resuscitation and on the clinical findings of fixed, dilated pupils, missing brainstem reflexes, and an asystole as an initially recorded cardiac rhythm. No certain clinical signs of death could be observed. In the face of this combination of conditions unfavourable for a successful resuscitation attempt and a survival of the patient, the emergency physician assumes an obvious futility of medical action. The individual criteria are analysed with respect ...Continue Reading

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