title: A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries.
abstract: BACKGROUND
  Europe is a patchwork of 47 countries with legal, cultural, religious, and economic differences. A prior study suggested variation in ethical resuscitation/end-of-life practices across Europe. This study aimed to determine whether this variation has evolved, and whether the application of ethical practices is associated with emergency care organisation.
  
  
  METHODS
  A questionnaire covering four domains of resuscitation ethics was developed based on consensus: (A) Approaches to end-of-life care and family presence during cardiopulmonary resuscitation; (B) Determinants of access to best resuscitation and post-resuscitation care; (C) Diagnosis of death and organ donation (D) Emergency care organisation. The questionnaire was sent to representatives of 32 countries. Responses to 4-choice or 2-choice questions pertained to local legislation and common practice. Positive responses were graded by 1 and negative responses by 0; grades were reconfirmed/corrected by respondents from 31/32 countries (97%). For each resuscitation/end-of-life practice a subcomponent score was calculated by grades' summation. Subcomponent scores' summation resulted in domain total scores.
  
  
  RESULTS
  Data from 31 countries were analysed. Domains A, B, and D total scores exhibited substantial variation (respective total score ranges, 1-41, 0-19 and 9-32), suggesting variable interpretation and application of bioethical principles, and particularly of autonomy. Linear regression revealed a significant association between domain A and D total scores (adjusted r(2)=0.42, P<0.001).
  
  
  CONCLUSIONS
  According to key experts, ethical practices and emergency care still vary across Europe. There is need for harmonised legislation, and improved, education-based interpretation/application of bioethical principles. Better application of ethical practices may be associated with improved emergency care organisation.
authors.affiliation: University of Athens Medical School, Athens, Greece. Electronic address: sdmentzelopoulos@yahoo.com.
authors.forename: Spyros D
authors.initials: SD
authors.lastname: Mentzelopoulos
authors.affiliation: University of Antwerp, Antwerp, Belgium.
authors.forename: Leo
authors.initials: L
authors.lastname: Bossaert
authors.affiliation: Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbia.
authors.forename: Violetta
authors.initials: V
authors.lastname: Raffay
authors.affiliation: Medical School, University of Crete, Heraklion, Greece; Ethics Committee of the European Society for Emergency Medicine (EuSEM), London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Askitopoulou
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.affiliation: University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Greif
authors.affiliation: Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Kirstie
authors.initials: K
authors.lastname: Haywood
authors.affiliation: University Hospital and University Ghent, Ghent, Belgium; Federal Department Health, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van de Voorde
authors.affiliation: University of Athens, Medical School, Athens, Greece; Midwestern University, Chicago, IL, USA.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000941:ethics*; D002648:Child; D002675:Child, Preschool; D004992:Ethics, Medical; D005060:Europe; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007857:Leadership; D016014:Linear Models; D008297:Male; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics*
keywords: Bioethics; Cardiac arrest; Emergency care; End of life care; Resuscitation