Intensive Care Medicine

, Volume 44, Issue 6, pp 703–716 | Cite as

Ethical challenges in resuscitation

  • Spyros D. MentzelopoulosEmail author
  • Anne-Marie Slowther
  • Zoe Fritz
  • Claudio Sandroni
  • Theodoros Xanthos
  • Clifton Callaway
  • Gavin D. Perkins
  • Craig Newgard
  • Eleni Ischaki
  • Robert Greif
  • Erwin Kompanje
  • Leo Bossaert



A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation.


Following agreement on the article’s outline, subgroups of 2–3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered.


Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals’ education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased.


Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research.


Resuscitation Personal autonomy Beneficence Social justice 



The authors are grateful to Prof. Antonio G. Spagnolo, Director of the Institute of Bioethics and Medical Humanities Università Cattolica del Sacro Cuore, Rome, Italy, for offering useful advice during manuscript preparation. The authors acknowledge the support of the European Resuscitation Council for the conduct of teleconferences.

Compliance with ethical standards

Conflicts of interest

Gavin Perkins has received research funding from the National Institute for Health Research to conduct studies in cardiac arrest; he holds volunteer roles within the Resuscitation Council (UK), European Resuscitation Council and International Liaison Committee on Resuscitation. Leo Bossaert holds volunteer roles within the European Resuscitation Council. Robert Greif holds a volunteer role within the European Resuscitation Council and International Liaison Committee on Resuscitation. No other author has a conflict of interest to disclose.

Supplementary material

134_2018_5202_MOESM1_ESM.doc (418 kb)
Supplementary material 1 (DOC 417 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Spyros D. Mentzelopoulos
    • 1
    Email author
  • Anne-Marie Slowther
    • 2
  • Zoe Fritz
    • 3
  • Claudio Sandroni
    • 4
  • Theodoros Xanthos
    • 5
    • 6
  • Clifton Callaway
    • 7
  • Gavin D. Perkins
    • 2
  • Craig Newgard
    • 8
  • Eleni Ischaki
    • 1
  • Robert Greif
    • 9
  • Erwin Kompanje
    • 10
  • Leo Bossaert
    • 11
    • 12
  1. 1.First Department of Intensive Care MedicineNational and Kapodistrian University of Athens Medical School, Evaggelismos General HospitalAthensGreece
  2. 2.Division of Health SciencesWarwick Medical School, Gibbet Hill CampusCoventryUK
  3. 3.Acute Medicine, Cambridge University Hospitals NHS Foundation TrustCambridgeUK
  4. 4.Istituto Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Fondazione Policlinico, Universitario Agostino GemelliRomeItaly
  5. 5.European UniversityEngomiCyprus
  6. 6.President Hellenic Society of Cardiopulmonary ResuscitationAthensGreece
  7. 7.University of PittsburghPittsburghUSA
  8. 8.Department of Emergency Medicine Oregon Health and Science University PortlandCenter for Policy and Research in Emergency MedicinePortlandUSA
  9. 9.Department of Anesthesiology and Pain TherapyUniversity of Bern, Bern University HospitalBernSwitzerland
  10. 10.Department of Intensive Care, Department of Ethics and Philosophy of MedicineErasmus MC University Medical CenterRotterdamThe Netherlands
  11. 11.Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
  12. 12.European Resuscitation CouncilNielBelgium

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