Ethical issues of cardiopulmonary resuscitation: current practice among emergency physicians.
OBJECTIVE
To determine current practice and attitudes among emergency physicians (EPs) regarding the initiation and termination of CPR.


METHODS
An anonymous survey was mailed to randomly selected EPs. Main outcome measures included respondents' answers to questions regarding outcome of resuscitation, and current practice regarding initiation, continuation, and termination of resuscitation for victims of cardiopulmonary arrest.


RESULTS
The 1,252 respondents were from all 50 states, a variety of practice settings, and varying board certification. Most (78%) respondents honor legal advance directives regarding resuscitation. Few (7%) follow unofficial documents, or verbal reports of advance directives (6%). Many (62%) make decisions regarding resuscitation because of fear of litigation or criticism. A majority (55%) have recently attempted numerous resuscitations despite expectations that such efforts would be futile. Most respondents indicated that ideally, legal concerns should not influence physician practice regarding resuscitation (78%), but that in the current environment, legal concerns do influence practice (94%).


CONCLUSIONS
Most EPs attempt to resuscitate patients in cardiopulmonary arrest, regardless of futility, except in cases where a legal advance directive is available. Many EPs' decisions regarding resuscitation are based on concerns of litigation and criticism, rather than their professional judgment of medical benefit or futility. Compliance with patients' wishes regarding resuscitation is low unless a legal advance directive is present. Possible solutions to these problems may include standardized guidelines for the initiation and termination of CPR, tort reform, and additional public education regarding resuscitation and advance directives.
Marco
C A
CA
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. cmarco@welchlink.welch.jhu.edu
Bessman
E S
ES
Schoenfeld
C N
CN
Kelen
G D
GD
D024362:Advance Directive Adherence; D016223:Advance Directives / Q000331:legislation & jurisprudence; D001294:Attitude to Health; D016887:Cardiopulmonary Resuscitation / Q000592:standards / Q000706:statistics & numerical data*; D003625:Data Collection; D004635:Emergency Medicine / Q000331:legislation & jurisprudence / Q000592:standards*; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D018447:Medical Futility; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011897:Random Allocation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States