A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries

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• 作者：Spyros D. Mentzelopoulos^a ; ^{sdmentzelopoulos@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; ^{sdm@hol.gr" class="auth_mail" title="E-mail the corresponding author} ; Leo Bossaert^b ; Violetta Raffay^c ; Helen Askitopoulou^d ; ^e ; Gavin D. Perkins^f ; ^g ; Robert Greif^h ; Kirstie Haywoodⁱ ; Patrick Van de Voorde^j ; ^k ; Theodoros Xanthos^l ; ^m
• 关键词：Cardiac arrest ; Resuscitation ; Bioethics ; End of life care ; Emergency care
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：100
• 期：Complete
• 页码：11-17
• 全文大小：536 K

文摘

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.

d="absSec_2">Methods

d="spar0010">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.

d="absSec_3">Results

d="spar0015">Data from 31 countries were analysed. Domains A, B, and D total scores exhibited substantial variation (respective total score ranges, 1&ndash;41, 0&ndash;19 and 9&ndash;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 r² = 0.42, P < 0.001).

d="absSec_4">Conclusions

d="spar0020">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.