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Ethics in Resuscitation

  • Antonio E. Muñiz
Part of the Contemporary Cardiology book series (CONCARD)

Abstract

Seriously ill patients often face tragically difficult choices. Commonly, an advanced resuscitative intervention offers a chance of longer life, with a chance, too, of profound suffering. In a given day, all over the world, thousands undergo the procedure of cardiopulmonary resuscitation (CPR), whereas others are placed on a “do not attempt resuscitation” (DNAR) status. In the United States, it has been estimated that approx 100,000 lives may be saved with advanced resuscitation (1). The performance of CPR, however, may conflict with the patient’s own desires and may not be in his or her best interest, especially if suffering from a terminally ill condition. It has also been shown that up to 20% of individuals do not wish to be resuscitated (2,3). Decisions concerning CPR are complicated by the fact that often the decision to initiate CPR must be made within seconds by health care providers who generally have very little knowledge about the patient’s illness or of any existing advance directives.

Keywords

Health Care Provider Cardiac Arrest Emergency Medical Service Cardiopulmonary Resuscitation Advance Directive 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC)-Part I: Introduction. JAMA 1986; 255:2905–2914.Google Scholar
  2. 2.
    Skerrit U, Pitt B. ‘Do not resuscitate’: How? When? Why? Int J Geriatr Psychiatry 1997; 12:667–670.CrossRefGoogle Scholar
  3. 3.
    Evans AL, Brody BA. The do-not-resuscitate order in teaching hospitals. JAMA 1985; 253:2236–2239.PubMedCrossRefGoogle Scholar
  4. 4.
    Tunstall-Pedoe H. Do not resuscitate decisions. Resuscitation should not be part of every death. Br Med J 2001; 322:102–103.CrossRefGoogle Scholar
  5. 5.
    Baskett PJ. ABC of resuscitation. The ethics of resuscitation. Br Med J 1986; 293:189,190.Google Scholar
  6. 6.
    Hilberman M, Kutner J, Parsons D, Murphy DJ. Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR). J Med Ethics 1997; 23:361–367.PubMedGoogle Scholar
  7. 7.
    Schneiderman LJ, Kaplan RM, Pearlman RA, Teetzel H. Do physicians’ own preferences for lifesustaining treatment influence their perceptions of patients’ preferences? J Clin Ethics 1993; 4:28–33.PubMedGoogle Scholar
  8. 8.
    President’s Commission for the Study of Ethical Problems in medicine and Biomedical and Behavioral research. Making Health care decisions: the legal and ethical implications of informed consent in the patient-practitioner relationship. Washington DC: United States Government Printing Office, 1982.Google Scholar
  9. 9.
    President’s Commission for the study of ethical problems in medicine and biomedical and behavioral research. Deciding to forgo life-sustaining treatment: ethical, medical and legal issues in treatment decisions. Washington DC: United States Government Printing Office, 1983.Google Scholar
  10. 10.
    Perkins HS. Ethics at the end of life: practical principles for making resuscitation decisions. J Gen Intern Med 1986; 1:170–176.PubMedCrossRefGoogle Scholar
  11. 11.
    Quill TE, Brody H. Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 1996; 125:763–769.PubMedGoogle Scholar
  12. 12.
    Prendergast TJ. Resolving conflicts surrounding end-of-life care. New Horiz 1997; 5:62–71.PubMedGoogle Scholar
  13. 13.
    Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med 1996; 334:1578–1582.PubMedCrossRefGoogle Scholar
  14. 14.
    Evans DA, Funkenstein HH, Albert MS, et al. Prevalence of Alzheimer’s disease in a community population of older persons. Higher than previously reported. JAMA 1989; 262:2551–2556.PubMedCrossRefGoogle Scholar
  15. 15.
    Blank K, Robison J, Doherty E, Prigerson H, Duffy J, Schwartz HI: Life-sustaining treatment and assisted death choices in depressed older patients. J Am Geriatr Soc 2001; 49:153–161.PubMedCrossRefGoogle Scholar
  16. 16.
    Jackson DL, Youngner S. Patient autonomy and “death with dignity”: some clinical caveats. N Engl J Med 1979; 301:404–408.PubMedCrossRefGoogle Scholar
  17. 17.
    Marson DC, Hawkins L, McInturff B, Harrell LE. Cognitive models that predict physician judgements of capacity to consent in mild Alzheimer’s disease. J Am Geriatr Soc 1997; 45:458–464.PubMedGoogle Scholar
  18. 18.
    Appelbaum PS, Roth LH. Clinical issues in the assessment of competency. Am J Psychiatry 1981; 138: 1462–1467.PubMedGoogle Scholar
  19. 19.
    Brock DW. Surrogate decision-making for incompetent adults: an ethical framework. Mt Sinai J Med 1991; 58:388–392.PubMedGoogle Scholar
  20. 20.
    Seckler AB, Meier DE, Mulvihill M, Paris BE. Substituted judgement: how accurate are proxy predictions. Ann Intern Med 1991; 115:92–98.PubMedGoogle Scholar
  21. 21.
    Uhlmann RF, Pearlman RA. Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med 1991; 151:495–497.PubMedCrossRefGoogle Scholar
  22. 22.
    Bok S. Personal directions for care at the end of life. N Engl J Med 1976; 295:367–369.PubMedCrossRefGoogle Scholar
  23. 23.
    Sulmasy DP, Terry PB, Weisman CS, et al. The accuracy of substituted judgements in patients with terminal diagnoses. Ann Intern Med 1998; 128:621–629.PubMedGoogle Scholar
  24. 24.
    Sehgal A, Galbraith A, Chesney M, Schdenfeld P, Charles G, Lo B. How strictly do dialysis patients want their advance directives followed? JAMA 1992; 267:59–63.PubMedCrossRefGoogle Scholar
  25. 25.
    Emanuel EJ, Emanuel LL. Proxy decision-making for incompetent patients: An ethical and empirical analysis. JAMA 1992; 267:2067–2071.PubMedCrossRefGoogle Scholar
  26. 26.
    Lynn J. Conflicts of interest in medical decision-making. J Am Geriatr Soc 1988; 36:945–950.PubMedGoogle Scholar
  27. 27.
    Annas GJ. The health care proxy and the living will. N Eng J Med 1991; 324:1210–1213.CrossRefGoogle Scholar
  28. 28.
    Weir RF, Gostin L. Decisions to abate life-sustaining treatment for nonautonomous patients: ethical standards and legal liability for physicians after Cruzan. JAMA 1990; 264:1846–1853.PubMedCrossRefGoogle Scholar
  29. 29.
    Gillick M. The high costs of dying: a way out. Arch Intern Med 1994; 154:2134–2137.PubMedCrossRefGoogle Scholar
  30. 30.
    Menikoff JA, Sachs GA, Siegler M. Beyond advance directives-health care surrogate laws. N Engl J Med 1992; 327:1165–1169.PubMedCrossRefGoogle Scholar
  31. 31.
    Lo B, Rouse F, Dornbrand L. Family decision-making on trial. Who decides for incompetent patients? N Engl J Med 1990; 322:1228–1232.PubMedCrossRefGoogle Scholar
  32. 32.
    Lurie N, Pheley AM, Miles SH, Bannick-Mohrland S: Attitudes toward discussing life-sustaining treatments in extended care facitlity patients. J Am Geriatr Soc 1992; 40:1205–1208.PubMedGoogle Scholar
  33. 33.
    Hofmann JC, Wenger NS, Davis EB et al. Patient preferences for communication with physicians about end-of-life decisions. SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 1997; 127:1–12.PubMedGoogle Scholar
  34. 34.
    Kennedy BJ. Communicating with patients about advanced cancer. JAMA 1998; 280: 1403,1404.PubMedCrossRefGoogle Scholar
  35. 35.
    The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospital patients: the study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). JAMA 1995; 274: 1591–1598.Google Scholar
  36. 36.
    Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ: Advance directives for medical care—a case for greater use. N Engl J Med 1991; 324:889–895.PubMedCrossRefGoogle Scholar
  37. 37.
    Krumholz H, Philips RS, Hamel MB, et al. Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT project. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Circulation 1998; 98:648–655.PubMedGoogle Scholar
  38. 38.
    Ebell MH, Doukas DJ, Smith MA. The do-not-resuscitate order: a comparison of physician and patient preferences and decision-making. Am J Med 1991; 91:255–260.PubMedCrossRefGoogle Scholar
  39. 39.
    Brunetti LL, Carperos SD, Westlund RE. Physicians’ attitudes toward living wills and cardiopulmonary resuscitation. J Gen Intern Med 1991; 6:323–329.PubMedCrossRefGoogle Scholar
  40. 40.
    Bedell S, Delbanco T. Choices about cardiopulmonary resuscitation in the hospital: When do physicians talk with patients? New Engl J Med 1984; 310:1089–1093.PubMedCrossRefGoogle Scholar
  41. 41.
    Johnston SC, Pfeifer MP. End-of-Life Study Group. Patient and physician roles in end-of-life decision-making. J Gen Intern Med 1998; 13:43–45.CrossRefGoogle Scholar
  42. 42.
    Johnson SC, Pfeifer MP, McNutt R. The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End-of-Life Study Group. Arch Intern Med 1995; 155: 1025–1030.CrossRefGoogle Scholar
  43. 43.
    Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA 1997; 278:733–738.PubMedCrossRefGoogle Scholar
  44. 44.
    Hill TP. Treating the dying patient. The challenge for medical education. Arch Intern Med 1995; 155: 1265–1269.PubMedCrossRefGoogle Scholar
  45. 45.
    Tierney WM, Dexter PR, Gramelspacher GP, Perkins AJ, Zhou XH, Wolinsky FD. The effect of discussions about advance directives on patients’ satisfaction with primary care. J Gen Intern Med 2001; 16:32–40.PubMedCrossRefGoogle Scholar
  46. 46.
    Sowden AJ, Forbes C, Entwistle V, Watt I. Informing, communicating and sharing decisions with people who have cancer. Qual Health Care 2001; 10:193–196.PubMedCrossRefGoogle Scholar
  47. 47.
    Layson RT, Adelman HM, Wallach PM, Pfeifer MP, Johnstons S, McNutt RA. Discussions about the use of life-sustaining treatments: a literature review of physicians’ and patient’ attitudes and practices. End of Life Study Group. J Clin Ethics 1994; 5:195–203.PubMedGoogle Scholar
  48. 48.
    Hill M, MacQuillan G, Forsyth M, Heath DA. Cardiopulmonary resuscitation: who makes the decision? Br Med J 1994; 308:1677.Google Scholar
  49. 49.
    De Vos R, Haes HC, Koster RW, de Haan RJ. Quality of survival after cardiopulmonary resuscitation. Arch Intern Med 1999; 159:249–254.PubMedCrossRefGoogle Scholar
  50. 50.
    Marik PE, Varon J, Lisbon A, Reich HS. Physicians’ own preferences to the limitation and withdrawal of life-sustaining therapy. Resuscitation 1999; 42:197–201.PubMedCrossRefGoogle Scholar
  51. 51.
    Phillips R, Wenger N, Teno J, et al. Choices of seriously ill patients about cardiopulmonary resuscitation: correlates and outcome. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Am J Med 1996; 100:128–137.PubMedCrossRefGoogle Scholar
  52. 52.
    Schonwetter RS, Walker RM, Solomon M, Indurkhya A, Robinson BE. Life values, resuscitation preferences, and the applicability of living wills in older population. J Am Geriatr Soc 1996; 44:954–958.PubMedGoogle Scholar
  53. 53.
    Hamel MB, Lynn J, Teno JM, et al. Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. J Am Geriatr Soc 2000; 48(Suppl):S176–S182.PubMedGoogle Scholar
  54. 54.
    Yeo CL, Tudehope DI. Outcome of resuscitated apparently stillborn infants: a ten year review. J Paediatr Child Health 1994; 30:129–133.PubMedGoogle Scholar
  55. 55.
    Casalaz DM, Marlow N, Speidel BD. Outcome of resuscitation following unexpected apparent stillbirth. Arch Dis Child Fetal Neonatal Ed 1998; 78:F112–F115.PubMedCrossRefGoogle Scholar
  56. 56.
    Slevin ML, Stubbs L, Plant HJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 1990; 300:1458–1460.PubMedGoogle Scholar
  57. 57.
    Cruzan v Missouri Department of Health. 497 U.S. 111 L.Ed.2d, 110 SCt. 2841 (1990).Google Scholar
  58. 58.
    Tomlinson T, Brody H. Ethics and communication and do not resuscitate orders. N Engl J Med 1988; 318:43–46.PubMedCrossRefGoogle Scholar
  59. 59.
    Charlson ME, Sax FL, MacKenzie CR, Fields SP, Braham RL, Douglas RG Jr. Resuscitation: how do we decide? A prospective study of physicians’ preferences and the clinical course of hospitalized patients. JAMA 1986; 255:1316–1322.PubMedCrossRefGoogle Scholar
  60. 60.
    Stewart AL, Teno J, Patrick DL, Lynn J. The concept of life of dying persons in the context of health care. J Pain Symptom Management 1999; 17:93–108.CrossRefGoogle Scholar
  61. 61.
    Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspective. JAMA 1999; 281:163–168.PubMedCrossRefGoogle Scholar
  62. 62.
    Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994; 330:592–596.PubMedCrossRefGoogle Scholar
  63. 63.
    Rabkin MT, Gillerman G, Rice NR. Orders not to resuscitate. N Engl J Med 1976; 295:364–366.PubMedCrossRefGoogle Scholar
  64. 64.
    Youngner SJ. Who defines futility? JAMA 1988; 260:2094,2095.PubMedCrossRefGoogle Scholar
  65. 65.
    Tomlinson T, Brody H. Futility and the ethics of resuscitation. JAMA 1990; 264:1276–1280.PubMedCrossRefGoogle Scholar
  66. 66.
    Brett AS, McCullough LB. When patients request specific interventions: defining the limits of the physician’s obligation. N Engl J Med 1986; 315:1347–1351.PubMedCrossRefGoogle Scholar
  67. 67.
    Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med 1983; 309:569–576.PubMedCrossRefGoogle Scholar
  68. 68.
    Ebell MH, Bergus GR, Warbasse L, Bloomer R. The inability of physicians to predict the outcome of in-hospital resuscitation. J Gen Intern Med 1996; 11:16–22.PubMedCrossRefGoogle Scholar
  69. 69.
    Vitelli CE, Cooper K, Rogatko A, Brennan MF. Cardiopulmonary resuscitation and the patient with cancer. J Clin Oncol 1991; 9:111–115.PubMedGoogle Scholar
  70. 70.
    Bonnin MJ, Pepe PE, Kimball KT, Clark PS Jr. Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 1993; 270:1457–1462.PubMedCrossRefGoogle Scholar
  71. 71.
    Sirbaugh PE, Pepe P, Shook JE, Kimball KT, Goldman MJ, Ward MA, Mann DM. A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest [see comments] [published erratum appears in Ann Emerg Med 1999; 33: 358]. Ann Emerg Med 1999; 33:174–184.PubMedCrossRefGoogle Scholar
  72. 72.
    Barzilay Z, Somekh M, Sagy M, Boichis H. Pediatric cardiopulmonary resuscitation outcome. J Med 1998; 19:229–241.Google Scholar
  73. 73.
    Zaritsky A, Nadkarni V, Getson P, Kuehl K. CPR in children. Ann Emerg Med 1987; 16:1107–1111.PubMedCrossRefGoogle Scholar
  74. 74.
    Kuisma M, Suominen P, Korpela R. Paediatric out-of-hospital cardiac arrest: epidemiology and outcome. Resuscitation 1995; 30:141–150.PubMedCrossRefGoogle Scholar
  75. 75.
    Torphy DE, Minter MG, Thompson BM. Cardiorespiratory arrest and resuscitation in children. Am J Dis Child 1984; 138:1099–1102.PubMedGoogle Scholar
  76. 76.
    O’Rourke PP. Outcome of children who are apneic and pulseless in the emergency room. Crit Care Med 1986; 14:466–468.PubMedCrossRefGoogle Scholar
  77. 77.
    Schindler MB, Bohn D, Cox PN, et al. Outcome of out-of-hospital cardiac or respiratory arrest in children [see comments]. N Engl J Med 1996; 335:1473–1479.PubMedCrossRefGoogle Scholar
  78. 78.
    Ebell MH, Bergus GR, Warbasse L, Bloomer R. The inability of physicians to predict the outcome of in-hospital resuscitation. J Gen Intern Med 1996; 11:16–22.PubMedCrossRefGoogle Scholar
  79. 79.
    Davis DJ. How aggressive should delivery room cardiopulmonary resuscitation be for extremely low birth weight neonates? [see comments]. Pediatr 1993; 92:447–450.Google Scholar
  80. 80.
    American College of Emergency Physicians. Guidelines for ‘do not resuscitate orders’ in the prehospital setting. Ann Emerg Med 1988; 17:1106–1108.CrossRefGoogle Scholar
  81. 81.
    Miles SH, Crimmins TJ. Orders to limit emergency treatment for ambulance service in a large metropolitan area. JAMA 1985; 254:525–527.PubMedCrossRefGoogle Scholar
  82. 82.
    Parrish GA, Holdren KS, Skiendzielewski JJ, Lumpkin OA. Emergency department experience with sudden death: a survey of survivors. Ann Emerg Med 1987; 16:792–796.PubMedCrossRefGoogle Scholar
  83. 83.
    Kellermann Al, Staves DR, Hackman BB. In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support. “heroic efforts” or an exercise in futility? Ann Emerg Med 1988; 17: 589–594.PubMedCrossRefGoogle Scholar
  84. 84.
    Gray WA, Capone RJ, Most AS. Unsuccessful emergency medical resuscitation are continued efforts in the emergency department justified? N Engl J Med 1991; 325:1393–1398.PubMedCrossRefGoogle Scholar
  85. 85.
    Bonnin MJ, Swor RA. Outcomes in unsuccessful field resuscitation attempts. Ann Emerg Med 1989; 18: 507–512.PubMedCrossRefGoogle Scholar
  86. 86.
    Bonnin MJ, Pepe PE, Kimball KT, Clark PS Jr. Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 1993; 270:1457–1462.PubMedCrossRefGoogle Scholar
  87. 87.
    Weaver WD. Resuscitation outside the hospital: what’s lacking? N Engl J Med 1991; 325: 1437–1439.PubMedCrossRefGoogle Scholar
  88. 88.
    Gray WA, Capone RJ, Most AS. Unsuccessful emergency medical resuscitations: are continued efforts in the emergency department justified? N Engl J Med 1991; 325:1393–1398.PubMedCrossRefGoogle Scholar
  89. 89.
    Delbridge TR, Fosnocht DE, Garrison HG, Auble TE. Field termination of unsuccessful out-of-hospital cardiac arrest resuscitations: acceptance by family members. Ann Emerg Med 1996; 27:649–654.PubMedCrossRefGoogle Scholar
  90. 90.
    Iserson KV. Foregoing prehospital care: should ambulance staff always resuscitate? J Med Ethics 1991: 17:19–24.PubMedGoogle Scholar
  91. 91.
    Hanson C, Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department’s nine-year perspective. J Emerg Nurs 1992; 18:104–106.PubMedGoogle Scholar
  92. 92.
    Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J Emerg Nurs 1998; 24:400–405.PubMedCrossRefGoogle Scholar
  93. 93.
    Barrat F, Wallis DN. Relatives in the resuscitation room: their point of view [see comments]. J Accid Emerg Med 1998; 15:109–111.Google Scholar
  94. 94.
    Boie ET, Moore GP, Brummett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Ann Emerg Med 1999; 34:70–74.PubMedCrossRefGoogle Scholar
  95. 95.
    Doyle CJ, Post H, Burney RE, Maino J, Kee FE, Rhee KJ. Family participation during resuscitation: an option. Ann Emerg Med 1987; 16:673–675.PubMedCrossRefGoogle Scholar
  96. 96.
    Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet 1998; 352:614–617.PubMedCrossRefGoogle Scholar
  97. 97.
    Offord RJ. Should relatives of patients with cardiac arrest by invited to be present during cardiopulmonary resuscitation? Intensive Crit Care Nurs 1998; 14:288–293.PubMedCrossRefGoogle Scholar
  98. 98.
    Bouchner H, Vinci R, Waring C. Pediatric procedures: do parents want to watch? Pediatrics 1989; 84:907–909.PubMedGoogle Scholar
  99. 99.
    Sacchetti A, Lichenstein R, Carraccio CA, Harris RH. Family member presence during pediatric emergency department procedures. Pediatr Emerg Care 1996; 12:268–271.PubMedCrossRefGoogle Scholar
  100. 100.
    Boudreaux ED, Francis JL, Loyacano T. Family presence during invasive procedures and resuscitations in the emergency department: a critical review and suggestions for future research. Ann Emerg Med 2002; 40: 193–205.PubMedCrossRefGoogle Scholar
  101. 101.
    Eichhorn DJ, Meyers TA, Mitchell TG, Guzzetta CE. Opening the doors: family presence during resuscitation. J Cardiovas Nurs 1996; 10:59–70.Google Scholar
  102. 102.
    Walters DT, Tupin JP. Family grief in the emergency department. Emerg Med Clin North Am 1991; 9: 189–206.PubMedGoogle Scholar
  103. 103.
    Jones WH. Emergency room sudden death: What can be done for the survivors? Death Education 1978; 2: 231–245.PubMedCrossRefGoogle Scholar
  104. 104.
    Kubler-Ross E. On death and dying. JAMA 1972; 221:174–179.PubMedCrossRefGoogle Scholar
  105. 105.
    Dubin WR, Sarnoff JR. Sudden unexpected death: intervention with survivors. Ann Emerg Med 1986; 15:54–57.PubMedCrossRefGoogle Scholar
  106. 106.
    Robinson MA. Informing the family of sudden death. Am Fam Physician 1981; 23:115–118.PubMedGoogle Scholar
  107. 107.
    O’Keeffe KM. Death and dying. J Am College Emerg Physicians (JACEP) 1979; 8:275–279.CrossRefGoogle Scholar
  108. 108.
    Creek LV. How to tell the family that the patient has died. Postgrad Med 1980; 68:207–209.PubMedGoogle Scholar
  109. 109.
    Hamilton GC. Sudden death in the ED: telling the living. Ann Emerg Med 1988; 17:382.PubMedCrossRefGoogle Scholar
  110. 110.
    Willis RW. Bereavement management in the emergency department. J Emerg Nurs 1977; 3:35–39.PubMedGoogle Scholar
  111. 111.
    Cathcart F. Seeing the body after death. Br Med J 1988; 297:997,998.Google Scholar
  112. 112.
    Lindemann E. Symptomatology and management of acute grief. Am J Psychiatry 1994; 151(Suppl): 155–160.PubMedGoogle Scholar
  113. 113.
    Biros MH, Lewis RJ, Olson CM, Ronge JW, Cummins RO, Fost N. Informed consent in emergency research. Consensus statement from the Coalition Conference of Acute Resuscitation and Critical Care Researchers. JAMA 1995; 273:1283–1287.PubMedCrossRefGoogle Scholar
  114. 114.
    Wolf SM, Boyle P, Callahan D, et al. Sources of concern about the Patient Self-Determination Act. N Engl J Med 325:1666–1671.Google Scholar
  115. 115.
    Abramson NS, Meisel A, Safar P. Informed consent in resuscitation research. JAMA 1981; 246: 2828–2830.PubMedCrossRefGoogle Scholar
  116. 116.
    Abramson NS, Meisel A, Safar P. Deferred consent. A new approach for resuscitation research on comatose patients. JAMA 1986; 255:2466–2471.PubMedCrossRefGoogle Scholar
  117. 117.
    Abramson NS, Safar P. Deferred consent: use in clinical resuscitation. Brain Resuscitation Clinical Trial II Study Group. Ann Emerg Med 1990; 19:781–784.PubMedCrossRefGoogle Scholar
  118. 118.
    Garns MK, Vassbo K, Forde R. Intubation training on the deceased newborn: parents’ opinion? Tidsskr Nor Laegenforen 1999; 119:39–41.Google Scholar
  119. 119.
    Department of Health and Human Services, US Food and Drug Administration. Protection of human subjects: informed consent and waiver of informed consent requirements in certain emergency research. 61 Federal Register. 51528 (1996) (codified at 21 CFR §50.24 and §46.408).Google Scholar
  120. 120.
    Benfield DG, Flaksman RJ, Lin TH, Kantak AD, Kokomoor FW, Vollman JH. Teaching intubation skills using newly deceased infants. JAMA 1991; 265:2360–2363.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Antonio E. Muñiz
    • 1
    • 2
  1. 1.Department of Emergency MedicineVirginia Commonwealth University Medical CenterRichmond
  2. 2.Department of PediatricsVirginia Commonwealth University Medical CenterRichmond

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