Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T04:35:53.108Z Has data issue: false hasContentIssue false
  • English
  • Français

The Ethics of Resuscitation: How Do Paramedics Experience Ethical Dilemmas when Faced with Cancer Patients with Cardiac Arrest?

Published online by Cambridge University Press:  19 March 2012

Halvor Nordby  and
Øyvind Nøhr
Halvor Nordby*
Affiliation:
Department of Health and Society, University of Oslo, Oslo, Norway Department of Health and Social Work, Lillehammer University College, Lillehammer, Norway
Øyvind Nøhr
Affiliation:
Department of Health and Social Work, Lillehammer University College, Lillehammer, Norway
*
Correspondence: Halvor Nordby, MPhil, PhD Department of Health and Society, University of Oslo, PO Box 1089, 0317 Oslo, Norway, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: Research on prehospital emergency work traditionally has focused on medical issues, but paramedics often have to make ethical choices. The goal of this exploratory study was to understand how paramedics experience difficult ethical dilemmas regarding resuscitation of cancer patients.

Methods: Paramedics from ambulance services in Norway were interviewed about resuscitation of cancer patients with cardiac arrest. The qualitative study included naturalistic, semi-structured interviews and a cognitive-emotional, interpretive approach.

Results: All study participants believed that it ethically can be correct not to resuscitate if the patient is expected to survive for only a short time with a very low quality of life and severe negative illness experiences. However, this belief sometimes failed to match formal or informal guidelines and contextual factors such as expectations of relatives. When confronting these challenges, the majority of the paramedics relied heavily on the advice of medical experts, but some had to make more autonomous decisions.

Discussion: The concept of a double pressure situation can be used to analyze the ethical dilemmas regarding resuscitation of cancer patients. The pressure from “below” is grounded in individual caring frameworks, and in the belief that it can be wrong to resuscitate. The pressure from “above” is objective and system-related, related to uncertainty, and grounded in the fundamental and irreducible value of human life.

Conclusions: The findings of this qualitative, exploratory study suggest that ethical concepts and analyses of double pressure situations should have an important role in education and training designed to prepare emergency personnel for difficult life and death choices. More research is needed to shed light on how ethical dilemmas arise in prehospital work.

Keywords

cancercardiac arrestcommunicationsdo-not-resuscitate orderemergencyethicalparamedicprehospitalresuscitation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 1 , February 2012 , pp. 64 - 70
Copyright
Copyright Nordby © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Estimate based on unpublished statistics from AMIS (Acute Medical Information System), the electronic operative system used by the national medical emergency call centers in Norway.Google Scholar
2.Kristjansson, S R, Wyller, T B.Discontinuation of prophylactic drugs to the elderly [in Norwegian]. Tidsskr Nor Laegeforen. 2010;130(17):1726–1728.CrossRefGoogle ScholarPubMed
3.Arnesen, K.The cancer registry of Norway [in Norwegian]. Tidsskr Nor Laegeforen. 2001;121(10):1256–1257.Google Scholar
4.Naess, AC, Steen, E, Steen, PA.Ethics in treatment decisions during out-of-hospital resuscitation. Resuscitation. 1997;33(3):245–256.CrossRefGoogle ScholarPubMed
5.Glover, J. The sanctity of life. In: Kuhse, H, Singer, P, eds, Bioethics: An Anthology. Oxford: Blackwell; 2006:266–276.Google Scholar
6.Brock, D. Medical decisions at the end of life. In: Kuhse, H, Singer, P, eds, A Companion to Bioethics. Oxford: Blackwell; 1998:231–242.Google Scholar
7.Ashcroft, R, Lucassen, A, Parker, M, Verkerk, M.Widdershoven, G.Case Analysis in Clinical Ethics. Cambridge: Cambridge University Press; 2005.CrossRefGoogle Scholar
8.Downie, RS, Calman, K.Healthy Respect: Ethics in Health Care. Oxford: Oxford University Press; 1994.CrossRefGoogle Scholar
9.Gutmann, A. Moral dilemmas. In: Frey, R, Wellman, C, eds, A Companion to Applied Ethics. Oxford: Blackwell; 2005:487–498.Google Scholar
10.Kuhse, H, Singer, P.Bioethics: An Anthology. Oxford: Blackwell; 2006:589–677.Google Scholar
11.Harris, J.Bioethics: Oxford Readings in Philosophy. Oxford: Oxford University Press; 2001.Google Scholar
12.Kuhse, H, Singer, P.A Companion to Bioethics. Oxford: Blackwell; 1998.Google Scholar
13.Davis, A, Arosker, M, Liaschenko, J, Drought, T.Ethical Dilemmas and Nursing Practice. Stamford, Connecticut, USA: Appleton & Lange; 1997:17–45.Google Scholar
14.Chaitin, E, Wood, J, Arnold, R. Communication in the ICU: Holding a family meeting. http://www.uptodate.com/contents/communication-in-the-icu-holding-a-family-meeting. Accessed January 22, 2012.Google Scholar
15.Stein-Parbury, J, Slade, D, Scheeres, H.Emergency communication: Understanding the challenges of effective patient–clinician interactions in emergency departments. Australasian Emergency Nursing Journal. 2007;10(4):212–217.CrossRefGoogle Scholar
16.Readert, T, Flin, R, Mearns, K, Cuthbertson B. Interdisciplinary communication in the intensive care unit. Br J Anaesth. 2007;3:347–352.CrossRefGoogle Scholar
17.Silverman, J, Kurtz, S, Draper, J.Skills for Communicating with Patients. Oxford: Radcliffe Publishing; 2005.Google Scholar
18.Van Vleet, L.Between black and white: The grey area of ethics in EMS. JEMS. 2006;31(10):55–56, 58–63.Google ScholarPubMed
19.Bamonti, A, Heilicser, B, Stotts, K.To treat or not to treat: Identifying ethical dilemmas in EMS. JEMS. 2001;26(3):100–107.Google ScholarPubMed
20.Sanders, M.Mosby’s Paramedic Textbook. St. Louis, Missouri, USA/London: Mosby; 2007.Google Scholar
21.Henry, M, Stapleton, E.EMT Prehospital Care. St. Louis, Missouri, USA/London: Mosby; 2010.Google Scholar
22.Nordby, H.Face-to-face and interactive communication: A perspective from philosophy of mind and language. Seminar.net 2006;2(2):1–25. http://seminar.net/index.php/volume-2-issue-2-2006-previousissuesmeny-114/67-interactive-and-face-to-face-communication. Accessed January 22, 2012.CrossRefGoogle Scholar
23.Dahlberg, K, Drew, N, Nyström, M.Reflective Lifeworld Research. Lund, Sweden: Studentlitteratur; 2001:146–180.Google Scholar
24.Pope, C, Mays, N.Qualitative Research in Health Care. Oxford: Blackwell; 2006.CrossRefGoogle Scholar
25.Miller, J, Glassner, B. The ‘inside’ and the ‘outside’: Finding realities in interviews. In: Silverman, D, ed, Qualitative Research: Theory, Method and Practice. London: Sage; 2004.Google Scholar
26.Gubriu, J, Holstein, J.The New Language of Qualitative Method. Oxford: Oxford University Press; 1997.Google Scholar
27.Bernstein, J.Beyond Objectivism and Relativism. Philadelphia: University of Pennsylvania Press; 1983.Google Scholar
28.Flick, U.An Introduction to Qualitative Research. London: Sage; 2002:73–133.Google Scholar
29.Bleicher, J.Contemporary Hermeneutics: Hermeneutics as Method, Philosophy and Critique. London: Routledge; 1980.Google Scholar
30.Freidson, E.Profession of Medicine. Chicago: Chicago University Press; 1986.Google Scholar
31.Johnson, D.Managing Knowledge Networks. Cambridge: Cambridge University Press; 2009.CrossRefGoogle Scholar
32.Buchbinder, S, Shanks, N.Introduction to Health Care Management. Burlington, Massachusetts, USA: Jones and Bartlett; 2011.Google Scholar
33.Freidson, E.Professionalism: The Third Logic. Chicago: The University of Chicago Press; 2001.Google Scholar
34.Parsons, V, Stanford, N.Interpersonal Interactions in Nursing. Menlo Park, California, USA: Addison-Wesley; 1979.Google Scholar
35.Steen, E, Naess, AC, Steen, PA.Paramedics organizational culture and their care for relatives of cardiac arrest victims. Resuscitation. 1997;34(1):57–63.CrossRefGoogle ScholarPubMed
36.Dancy, J.Moral Reasons. Oxford: Blackwell; 1996:73–104.Google Scholar
37.Knobe, J, Nichols, S.Experimental Philosophy. Oxford: Oxford University Press; 2008.CrossRefGoogle Scholar
38.Hunink, M, Glasziou, P.Decision Making in Health and Medicine. Cambridge: Cambridge University Press; 2003.Google Scholar
39.Seibold, D, Shea, B. Participation and decision making. In: Jablin, F, Putnam, F, eds, Organizational Communication. London: Sage; 2001.Google Scholar
40.Smith, A, Roberts, K.Interventions for post-traumatic stress disorder and psychological distress in emergency ambulance personnel: a review of the literature. Emerg Med J. 2003;20(1):75–78.CrossRefGoogle ScholarPubMed
41.Siriwardena, A, Donohoe, R, Stephenson, J et al. . Supporting research and development in ambulance services: Research for better health care in prehospital settings. Emerg Med J. 2010: 27(4):324–326.CrossRefGoogle ScholarPubMed
42.Rose, SC, Bisson, J, Churchill, R, Wessely, S.Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002;(2):CD000560. http://www.thecochranelibrary.com/userfiles/ccoch/file/CD000560.pdf. Accessed January 22, 2012.Google Scholar