Ethical issues on the factors involved in terminating Cardiopulmonary Resuscitation by healthcare providers / Hafizah Zainal Abidin

Cardiopulmonary resuscitation (CPR) is a standard treatment for cardiac arrest patients. The lack of guidelines on the exact duration of CPR has been a challenge for healthcare providers (HCP) to decide on the appropriate duration for CPR. As the factors determining the termination of CPR are multifactorial, this research aims to find the factors that influences a HCP’s decision to terminate CPR. This research is based on available guidelines and literatures. A total of 12 factors that influence HCP to determine the duration of CPR are identified. The factors are patients’ age, gender and comorbidity, cause of the cardiac arrest, initial arrest rhythm, witness availability of the arrest, arrest location, HCP influence, the presence of advance directives, medico-legal implications, family members’ influence and public influence. From these 12 factors, four themes were identified which are (i) patient factors, (ii) the arrest conditions, (iii) HCP’s influences on the termination of CPR, and (iv) non-clinical factors. The ethical issues in these four groups are then analysed and discussed. In applying the ethical factors for HCP to decide when to terminate CPR, the conceptual framework can be divided into three stages which are preparation before CPR, during CPR, and after CPR is completed. The result of this research will provide a conceptual framework of ethical practice for CPR in Malaysia.