Ethics in cardiopulmonary resuscitation

There is a minority of patients in whom resuscitation is inappropriate. It is important to identify such patients beforehand and communicate the decision not to attempt resuscitation to the would-be first responders. In the absence of the patient's expressed wishes, any decision not to attempt resuscitation must be made by the senior doctor in charge. This doctor will take into account a number of factors and, when appropriate, consult with medical and nursing colleagues relatives, etc. before making such a decision. There are many factors influencing the decision to terminate resuscitation once it has been started. These are listed and discussed. Legal aspects are addressed and indications are made of the expected performance of lay and professional rescuers working under a variety of circumstances. The various definitions of death are described in the light of modern medical practice and the possibility of organ transplantation. There is an increasing fear of infection hazards to the rescuer during mouth to mouth ventilation. The risks are discussed and the use of protective devices is encouraged if they are immediately available. Finally, guidelines for hospital ethical CPR policy are outlined in the hope that they will be considered for adoption on a national and international scale.