As-Salam-o-Alaikum Respected Subscribers and Readers,

The goals of resuscitation are to preserve life, restore health, relieve suffering, limit disability, and respect the individual’s decisions, rights and privacy. In our today’s post we will talk about the early decisions made by the individual (if known to us at time of help needed), ethical and social rights and whenever his/her privacy matters with life saving services/skills needed to be administered to him/her.

Decisions about cardiopulmonary resuscitation (CPR) efforts are often made in seconds by rescuers who may now know the victim of cardiac arrest or whether an advance directive exists or not. As a result, administration of CPR may be contrary to the individual’s desires or best interests. The below will help all, healthcare professionals and layman rescuers, to understand the requirements and ethics of administering resuscitation and basic life supporting skills in any life-threatening situation.

Ethical Principles:

Rescuers should consider ethical, legal, and cultural factors when caring for those in need of CPR. Although rescuers must play a role in resuscitation decision making, they should be guided by science, the individual patient or surrogate preferences, local policy, and legal requirements.

Principle of Respect for Autonomy:

The principle of respect for autonomy is an important social value in medical ethics and law. The principle is based on society’s respect for competent individual’s ability to make decisions about his or her own healthcare. Adults are presumed to have decision-making capability unless they are incapacitated or declared incompetent by a court of law. Truly informed decisions require a strong healthcare provider-patient relationship/communication and a 3-step process:

1:- the patient receives and understands accurate information about his or her conditions, prognosis, the nature of any proposes interventions, alternatives, and risks and benefits;

2:- the patient is asked to paraphrase the information to give the provider the opportunity to assess his or her understanding to correct any misimpressions; and

3:- the patient deliberates and chooses among alternatives and justifies his or her decision.

WHEN the individual’s preferences are unknown or uncertain, emergency conditions should be treated until further information is available.

Do Not Attempt Resuscitation (DNAR):

A Do Not Attempt Resuscitation (DNAR) Order is a legitimate document in which one expressed his/her desire to not attempt any resuscitation effort or clearly state to “Allow Natural Death” without any resuscitation attempts. A DNAR should explicitly describe the resuscitation interventions to be performed in the event of a life-threatening emergency. In most cases, a DNAR order is preceded by a documented discussion with the patient, family, or surrogate decision maker addressing the patient’s wishes about resuscitation interventions. In addition, some jurisdictions may require confirmation by a witness or a second treating physician.

Withholding and Withdrawing CPR Related to Out-of Hospital Cardiac Arrest (OHCA):

We, the First Aid, CPR and AED trainers teach our students (as per the guidelines states) to immediately begin CPR without seeking consent, because any delay in care dramatically decreases the chances of survival. While the general rule is to provide emergency treatment to a victim of cardiac arrest, there are a few exceptions where withholding CPR might be appropriate, as follows:

1:- Situations where attempts to perform CPR whould place the rescuer at risk of serious injury or mortal peril;

2:- Obvious clinical signs of irreversible death; &

3:- A valid, signed, and dated advance directive indicating that resuscitation is not desired, or a valid, signed, and dated DNAR order.

To Your Health & Safety,

Faisal Javed Mir & First Aid to Save a Life Pakistan

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