Cardiopulmonary resuscitation and ethics

The earliest documentation of cardiopulmonary resuscitation (CPR) dates to the Old Testament, which describes how the prophet Elisha resuscitated an apparently dead child by blowing air into his mouth.(1) Modern CPR began in 1960 with the landmark study by Kouwenhoven, Jude, and Knickerbocker, which reported combining closed chest compression, mouth-to-mouth breathing, and external defibrillation.(1) Since that time, CPR and advanced cardiac life support (ACLS) techniques have saved many lives but have also raised several ethical dilemmas. Consent for CPR procedures is universally presumed. However, there are times when patients' right to receive CPR contrasts with their caregivers' impression that such treatment is not medically indicated. Conversely, some patients receive resuscitation that they would not have wanted. Decisions regarding resuscitation and the duration of resuscitative efforts often entail several crucial ethical issues. This article will focus on the ethical dilemmas related to the need to make critical decisions in emergency or acute settings.