- Email: [email protected]
Ethical Issues at the End of Life
Policy Statements interest, the nature of the interest, any action taken to determine whether a conflict of interest was present, and the Board’s, committee’s, or section’s decision as to whether a conflict of interest existed; b. The extent of such individual’s participation in the relevant Board, committee, or section meeting on matters related to the possible conflict of interest; and c. The names of the individuals who were present for discussion and votes relating to the action, policy or arrangement in question, the content of the discussion including alternatives to the proposed action, policy or arrangement, and a record of any votes taken in connection therewith.
Ethical Issues at the End of Life [Ann Emerg Med. 2008;52:592.]
The American College of Emergency Physicians believes that under certain well-defined circumstances, resuscitative efforts may be discontinued in the out-of-hospital setting for pulseless patients who do not respond to an adequate trial of resuscitation therapy. The literature demonstrates that these are situations in which resuscitative efforts would be unlikely to provide medical benefit to the patient. Patients for whom resuscitative efforts may be discontinued in the out-of-hospital setting include patients who are asystolic or are in a wide-complex pulseless bradycardic rhythm with a rate less than 60, are normothermic, and fail an adequate trial of resuscitation therapy. Adequate resuscitation therapy may include airway management, CPR, medications, defibrillation, and pacing. When a process for field termination is established, a psychosocial support system should be available to help family members and friends. Local EMS systems must work together with appropriate local agencies to develop effective policies for field termination of resuscitation, to include appropriate involvement of medical control.
The American College of Emergency Physicians believes that: ● Emergency physicians play an important role in providing care at the end of life (EOL). ● Helping patients and their families achieve greater control over the dying process will improve EOL care. ● Advance care planning can help patients formulate and express individual wishes for EOL care and communicate those wishes to their health care providers by means of advance directives (including state approved advance directives, DNAR orders, living wills and durable powers of attorney for health care). To enhance EOL care in the Emergency Department, the American College of Emergency Physicians believes that emergency physicians should: ● Respect the dying patient’s needs for care, comfort, and compassion. ● Communicate promptly and appropriately with patients and their families about EOL care choices, avoiding medical jargon. ● Elicit the patient’s goals for care before initiating treatment, recognizing that EOL care includes a broad range of therapeutic and palliative options. ● Respect the wishes of dying patients including those expressed in advance directives. Assist surrogates to make EOL care choices for patients who lack decisionmaking capacity, based on the patient’s own preferences, values, and goals. ● Encourage the presence of family and friends at the patient’s bedside near the end of life, if desired by the patient. ● Protect the privacy of patients and families near the end of life. ● Promote liaisons with individuals and organizations in order to help patients and families honor EOL cultural and religious traditions. ● Develop skill at communicating sensitive information, including poor prognoses and the death of a loved one. ● Comply with institutional policies regarding recovery of organs for transplantation. ● Obtain informed consent from surrogates for postmortem procedures.
Revised and approved by the ACEP Board of Directors June 2008 Reaffirmed by the ACEP Board of Directors October 2002 Originally approved by the ACEP Board of Directors September 1997
Revised and approved by the ACEP Board of Directors titled, “Ethical Issues at the End of Life” June 2008 Originally approved by the ACEP Board of Directors titled, “Ethical Issues in Emergency Department Care at the End of Life” September 2003
doi:10.1016/j.annemergmed.2008.07.033
doi:10.1016/j.annemergmed.2008.07.035
Revised and approved by the ACEP Board of Directors June 2008 Reaffirmed by the ACEP Board of Directors October 2001 Approved by the ACEP Board of Directors September 1997 Approved by the ACEP Board of Directors January 1996 doi:10.1016/j.annemergmed.2008.07.037
Discontinuing Resuscitation in the Out-ofHospital Setting [Ann Emerg Med. 2008;52:592.]
592 Annals of Emergency Medicine
Volume , . : November
Ethical Issues at the End of Life [Ann Emerg Med. 2008;52:592.]
The American College of Emergency Physicians believes that under certain well-defined circumstances, resuscitative efforts may be discontinued in the out-of-hospital setting for pulseless patients who do not respond to an adequate trial of resuscitation therapy. The literature demonstrates that these are situations in which resuscitative efforts would be unlikely to provide medical benefit to the patient. Patients for whom resuscitative efforts may be discontinued in the out-of-hospital setting include patients who are asystolic or are in a wide-complex pulseless bradycardic rhythm with a rate less than 60, are normothermic, and fail an adequate trial of resuscitation therapy. Adequate resuscitation therapy may include airway management, CPR, medications, defibrillation, and pacing. When a process for field termination is established, a psychosocial support system should be available to help family members and friends. Local EMS systems must work together with appropriate local agencies to develop effective policies for field termination of resuscitation, to include appropriate involvement of medical control.
The American College of Emergency Physicians believes that: ● Emergency physicians play an important role in providing care at the end of life (EOL). ● Helping patients and their families achieve greater control over the dying process will improve EOL care. ● Advance care planning can help patients formulate and express individual wishes for EOL care and communicate those wishes to their health care providers by means of advance directives (including state approved advance directives, DNAR orders, living wills and durable powers of attorney for health care). To enhance EOL care in the Emergency Department, the American College of Emergency Physicians believes that emergency physicians should: ● Respect the dying patient’s needs for care, comfort, and compassion. ● Communicate promptly and appropriately with patients and their families about EOL care choices, avoiding medical jargon. ● Elicit the patient’s goals for care before initiating treatment, recognizing that EOL care includes a broad range of therapeutic and palliative options. ● Respect the wishes of dying patients including those expressed in advance directives. Assist surrogates to make EOL care choices for patients who lack decisionmaking capacity, based on the patient’s own preferences, values, and goals. ● Encourage the presence of family and friends at the patient’s bedside near the end of life, if desired by the patient. ● Protect the privacy of patients and families near the end of life. ● Promote liaisons with individuals and organizations in order to help patients and families honor EOL cultural and religious traditions. ● Develop skill at communicating sensitive information, including poor prognoses and the death of a loved one. ● Comply with institutional policies regarding recovery of organs for transplantation. ● Obtain informed consent from surrogates for postmortem procedures.
Revised and approved by the ACEP Board of Directors June 2008 Reaffirmed by the ACEP Board of Directors October 2002 Originally approved by the ACEP Board of Directors September 1997
Revised and approved by the ACEP Board of Directors titled, “Ethical Issues at the End of Life” June 2008 Originally approved by the ACEP Board of Directors titled, “Ethical Issues in Emergency Department Care at the End of Life” September 2003
doi:10.1016/j.annemergmed.2008.07.033
doi:10.1016/j.annemergmed.2008.07.035
Revised and approved by the ACEP Board of Directors June 2008 Reaffirmed by the ACEP Board of Directors October 2001 Approved by the ACEP Board of Directors September 1997 Approved by the ACEP Board of Directors January 1996 doi:10.1016/j.annemergmed.2008.07.037
Discontinuing Resuscitation in the Out-ofHospital Setting [Ann Emerg Med. 2008;52:592.]
592 Annals of Emergency Medicine
Volume , . : November