RESUSCITATION ETHICS IN ROMANIA: DO NOT ATTEMPT RESUSCITATION ORDERS. FACTS AND PERSPECTIVES
Abstract:
The cardiac arrest is an unfortunate event that ends the life of every human being. Sometimes, it is a predictable event in the evolution of chronic diseases, sometimes, it occurs as a complication of recently installed suffering. Trying to resuscitate the victim of cardiac arrest is a daily objective for the members of the emergency medical system (EMS), but decisions and gestures that initiate and conduct resuscitation may be subject to ethical issues. There are no regulations regarding the end of life decisions in Romania. So, in emergency cases, the medical personnel try to preserve the patient’s life by all means available. These gestures may prove to be futile and expensive. Emergency medical systems personnel may have clinical skills and moral abilities to decide whether or not to initiate CPR. But some factors, such as family pressure, lack of specific regulations, can cause futile resuscitation or even ”slow codes”. Many out of hospital cardiac arrests have been witnessed, but bystanders were not trained in CPR and did not perform CPR until EMS arrival. This shows the need for education in our country in the field of resuscitation. In patients who survive after a cardiac arrest, the drama goes on beyond the return of spontaneous circulation. Because of hypoxia, varying degrees of neurological sequelae occur, or even brain death. Most of these patients require constant care, the social reintegration being compromised. There are to discuss the psychological and psychiatric implications, both for survivors and their families. The choice to attempt resuscitation or not may be difficult in this context. Better training in the field of cardiopulmonary resuscitation may help reducing ethical dilemmas that the medical team may face.
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