Part 3: Ethical Issues 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

The goals of resuscitation are to preserve life; restore health; relieve suffering; limit disability; and respect individuals’ decisions, rights, and privacy. Because cardiopulmonary resuscitation (CPR) efforts must be initiated immediately at the time of arrest, a rescuer may not know who the victim is, what that individual’s goals of care are, or if an advance directive exists. As a result, administration of CPR may be contrary to the individual’s desires or best interests.1–3 This Part of the 2015 American Heart Association (AHA) Guidelines Update for CPR and Emergency Cardiovascular Care provides updates to the 2010 AHA Guidelines4 for healthcare providers who are faced with the difficult decision to provide or withhold emergency cardiovascular care. Ethical, legal, and cultural factors influence decisions about resuscitation. Ideally, these decisions are guided by science, patient or surrogate preferences, local policies and legal requirements, and established ethical principles. ### Principle of Respect for Autonomy Respect for autonomy is an important social value in medical ethics and law.5 This principle is based on society’s respect for a competent individual’s ability to make decisions about his or her own health care. Adults are presumed to have decision-making capability unless they are incapacitated or declared incompetent by a court of law. Informed decisions require that individuals receive and understand accurate information about their condition and prognosis as well as the nature, risks, benefits, and alternatives of any proposed interventions. Individuals must deliberate and choose among alternatives by linking their decisions to their values and personal goals of care. When physicians strive to understand patients’ goals of care, decisions can be made based on the likelihood that together they will achieve the patients’ goals of care. The following 3-step process may assist healthcare providers in ensuring each patient understands and makes informed decisions: (1) the patient receives and understands accurate …