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December 1992

Ceasing Futile Resuscitation in the Field: Ethical Considerations

Author Affiliations

School of Medicine Department of Medical History and Ethics Department of Philosophy University of Washington Seattle, WA 98195; Departments of Community and Family Medicine and of Medicine University of California at San Diego School of Medicine La Jolla, CA 92037

Arch Intern Med. 1992;152(12):2392-2397. doi:10.1001/archinte.1992.00400240016002

This article explores ethical decision making in the prehospital emergency setting with particular attention to emergency cardiac care. The first sections argue in support of current efforts to develop portable do-not-resuscitate (DNR) policies enabling patients' wishes to be honored outside the hospital setting. We then turn to the topic of futile resuscitation, and elaborate and defend a proposal to allow emergency personnel to cease futile resuscitation in the field. We submit that unlike the decision to write a DNR order, the judgment that resuscitation is futile ought not to depend on a patient's prior wishes. Instead, it should reflect a professional consensus and receive support from reliable empirical data. Finally, we acknowledge the difficulty of rendering reliable determinations of futility in the field, and show through case examples and empirical studies how effective policies can be implemented.

In emergency situations it is sometimes assumed that health care providers must use