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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: halvor.nordby@medisin.uio.no
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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

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