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The Significance of Professional Codes and Ethical Guidelines in Difficult Clinical Situations

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Codes of Ethics and Ethical Guidelines


When clinicians face ethical challenges, they may refer to professional codes and ethical guidelines for support. Whether and how professional codes and ethical guidelines have the function or potential to give ethical orientation and support to clinical care will be the core question of this chapter. The analysis will be carried out on the basis of an overview of the framework of Civil Law – as one form of codification – with a focus on recent legislation in Switzerland, also referring to international codes and guidelines.

Cardio-pulmonary resuscitation (CPR) is one of the most dramatic interventions in clinical care. Its success is based on numerous preconditions, both technical and logistical. It does, however, trigger severe ethical and legal complications as the decision making must take place very fast and has long-lasting effects (Mentzelopoulos et al. 2018). Clinical staff, therefore, needs to rely on guidance for security and prevention of errors.

Several (inter)national guidelines of mostly medical content exist offering clinical information and algorithms for CPR, but little ethical support.

This book chapter describes the development of a resuscitation guideline for a Swiss University Hospital. Challenges and obstacles for ethical support during the development will be reported and discussed. It concludes by considering what significance existing normative documents, especially ethical guidelines, have in general and with regard to the chosen clinical focus of CPR. Concerning the newly introduced ethics policy on CPR, ‘points to consider’ should help institutions creating ethical support helping physicians and patients tackle ethical challenges in clinical everyday life.

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  1. 1.


  • Barandun Schäfer, Ursi. 2011. Ethische Orientierungshilfe bei Widerstand von schwerkranken Menschen gegen Pflegemassnahmen – am Beispiel der Mundpflege. In Ethikkonsultation heute – vom Modell zur Praxis, ed. Ralf Stutzki, Kathrin Ohnsorge, and Stella Reiter-Theil, 185–197. Zürich: LIT Verlag.

    Google Scholar 

  • Bartels, Sandra, Mike Parker, Tony Hope, and Stella Reiter-Theil. 2005. Wie hilfreich sind ethische Richtlinien am Einzelfall? Ethik in der Medizin 17 (3): 191–205.

  • Bird, J., and S.A. Cohen-Cole. 1990. The three-function model of the medical interview. An educational device. Advances in Psychosomatic Medicine 20: 65–88.

    Article  Google Scholar 

  • Bjorklund, Pamela, and Denise M. Lund. 2019. Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations. Nursing Ethics 26 (1): 84–95.

  • Egger, Bernhard., Ruth Baumann-Hölzle, Max Giger, Claudia Käch, Audrey Kovatsch, Diana Meier-Allmendinger, Judit Pòk Lundqvist, Pascal. Schai, and Jean-Pierre Wils. 2017. Der «Schweizer Eid». Schweizerische Ärztezeitung 98 (40): 1295–1297.

    Google Scholar 

  • Eriksson, Stefan, Gert Helgesson, and A.T. Höglund. 2007. Being, Doing, and Knowing: Developing Ethical Competence in Health Care. Journal of Academic Ethics 5: 207–216.

  • Feldwisch-Drentrup, Hinnerk, and Anne Zegelman. 2017. Hippokratischer Eid - Deklaration von Genf kommt in der Gegenwart an. Ärzte Zeitung online.

    Google Scholar 

  • Frolic, Andrea N., Katherine Drolet, and H. H. S. Policy Working Group. 2013. Ethics policy review: a case study in quality improvement. Journal of Medical Ethics 39 (2): 98–103.

  • Frolic, Andrea, Katherine Drolet, Kim Bryanton, Carole Caron, Cynthia Cupido, Barb Flaherty, Sylvia Fung, and Lori McCall. 2012. Opening the black box of ethics policy work: evaluating a covert practice. The American Journal of Bioethics 12 (11): 3–15.

  • Gadmer Mägli, Ursula. 2017. Entscheidungen über den Reanimationsstatus im Kindes- und Erwachsenenschutz. Zeitschrift für Kindes- und Erwachsenenschutz: 104–125.

    Google Scholar 

  • German Medical Association. Verbindlichkeit von Richtlinien, Leitlinien, Empfehlungen und Stellungnahmen.

    Google Scholar 

  • Hauke, D., S. Reiter-Theil, E. Hoster, W. Hiddemann, and E.C. Winkler. 2011. The role of relatives in decisions concerning life-prolonging treatment in patients with end-stage malignant disorders: informants, advocates or surrogate decision-makers? Annals of Oncology 22 (12): 2667–2674.

  • Hermann, H., M. Trachsel, C. Mitchell, and N. Biller-Andorno. 2014. Medical decision-making capacity: knowledge, attitudes, and assessment practices of physicians in Switzerland. Swiss Medical Weekly 144: w14039.

  • Hostettler, Stefanie, Esther Kraft, and Christoph Bosshard. 2014. Grundlagenpapier der DDQ - Guidelines – Qualitätsmerkmale erkennen. Schweizerische Ärztezeitung 95 (3).

    Google Scholar 

  • Institute of Medicine. 2011. In Clinical Practice Guidelines We Can Trust, ed. Robin Graham, Michelle Mancher, Dianne Miller Wolman, Sheldon Greenfield, and Earl Steinberg. Washington, DC: The National Academies Press.

    Google Scholar 

  • Leven, Karl-Heinz. 1998. The Invention of Hippocrates: Oath, Letters and Hippocratic Corpus. In Ethics Codes in Medicine: Foundations and Achievements of Codification since 1947, ed. Ulrich Trohler and Stella Reiter-Theil, 3–23. Brookfield: Ashgate Pub.

    Google Scholar 

  • Lipkin, Mack, Samuel M. Putnam, and Aaron Lazare. 1995. The Medical Interview : Clinical Care, Education, and Research, Frontiers of primary care.

    Google Scholar 

  • Mentzelopoulos, Spyros D., Anne-Marie Slowther, Zoe Fritz, Claudio Sandroni, Theodoros Xanthos, Clifton Callaway, Gavin D. Perkins, Craig Newgard, Eleni Ischaki, Robert Greif, Erwin Kompanje, and Leo Bossaert. 2018. Ethical challenges in resuscitation. Intensive Care Medicine 44 (6): 703–716.

  • Mertz, Marcel., and Daniel Strech. 2014. Systematic and transparent inclusion of ethical issues and recommendations in clinical practice guidelines: a six-step approach. Implementation Science 9: 184.

  • Meyer-Zehnder, Barbara., Heidi A. Schleger, Sabine Tanner, Valentin Schnurrer, Deborah R. Vogt, Stella Reiter-Theil, and Hans Pargger. 2017. How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model. BMC Medical Ethics 18.

  • Monsieurs, Koenraad G., Jerry P. Nolan, Leo L. Bossaert, Robert Greif, Ian K. Maconochie, Nikolaos I. Nikolaou, Gavin D. Perkins, Jasmeet Soar, Anatolij Truhlar, Jonathan Wyllie, David A. Zideman, and ERC Guidelines 2015 Writing Grp. 2015. European Resuscitation Council Guidelines for Resuscitation 2015 Section 1. Executive summary. Resuscitation 95: 1–80.

  • Neumar, Robert W., Michael Shuster, Clifton W. Callaway, Lana M. Gent, Dianne L. Atkins, Farhan Bhanji, Steven C. Brooks, Allan R. de Caen, Michael W. Donnino, Jose Maria .E. Ferrer, Monica E. Kleinman, Steven L. Kronick, Eric J. Lavonas, Mark S. Link, MaryE. Mancini, Laurie J. Morrison, Robert E. O'Connor, Ricardo A. Samson, Steven M. Schexnayder, Eunice M. Singletary, Elizabeth H. Sinz, Andrew H. Travers, Myra H. Wyckoff, and Mary F. Hazinski. 2015. Part 1: Executive Summary 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 132 (18): S315–S367.

  • Parsa-Parsi, Ramin, and Urban Wiesing. 2017. Revision des ärztlichen Gelöbnisses. Deutsches Ärzteblatt 114 (44).

    Google Scholar 

  • Pfister, Eliane. 2010. Die Rezeption und Implementierung der SAMW-Richtlinien im medizinischen und pflegerischen Alltag. Schweizerische Ärztezeitung 91 (13/14).

    Google Scholar 

  • Pfister, Eliane, and Nikola Biller-Adorno. 2010. The reception and implementation of ethical guidelines of the Swiss Academy of Medical Sciences in medical and nursing practice. Swiss Medical Weekly 140 (11–12): 160–167.

    Google Scholar 

  • Reiter-Theil, Stella, Marcel Mertz, Jan Schurmann, Nicola Stingelin Giles, and Barbara Meyer-Zehnder. 2011. Evidence - competence - discourse: the theoretical framework of the multi-centre clinical ethics support project METAP. Bioethics 25 (7): 403–412.

  • Reiter-Theil, Stella., and Jan Schürmann. 2016. The “Big Five” in 100 Clinical Ethics Consultation Cases - Reviewing three years of ethics support in two Basel University Hospitals. Bioethica Forum 9 (2).

    Google Scholar 

  • ———. 2018. Evaluating Clinical Ethics Support: On What Grounds Do We Make Judgments About Reports of Ethics Consultation? In Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project, ed. S.G. Finder and M.J. Bliton, 165–178. Cham (CH).

    Google Scholar 

  • SAMS. 2013. Rechtliche Grundlagen im medizinischen Alltag - Ein Leitfaden für die Praxis. Basel: SAMW.

    Google Scholar 

  • ———. 2017. Swiss Academy of Medical Sciences - Decisions on cardiopulmonary resuscitation.

    Google Scholar 

  • Schweizerisches Strafgesetzbuch (SR 311).

    Google Scholar 

  • Schweizerisches Zivilgesetzbuch (SR 210).

    Google Scholar 

  • Shekelle, Paul G., Richard L. Kravitz, Jennifer Beart, Michael Marger, Mingming Wang, and Martin Lee. 2000. Are nonspecific practice guidelines potentially harmful? A randomized comparison of the effect of nonspecific versus specific guidelines on physician decision making. Health Services Research 34 (7): 1429–1448.

    Google Scholar 

  • Soar, Jasmeet, Michael W. Donnino, Ian Maconochie, Richard Aickin, Dianne L. Atkins, Lars W. Andersen, et al. 2018. 2018 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Circulation 138 (23): e714-e730.

  • Strech, Daniel, and Jan Schildmann. 2011. Quality of ethical guidelines and ethical content in clinical guidelines: the example of end-of-life decision-making. Journal of Medical Ethics 37 (7): 390–396.

  • Tröhler, Ulrich, Eckhard Herych, and Stella Reiter-Theil. 1998. Ethics codes in medicine : foundations and achievements of codification since 1947.

    Google Scholar 

  • Winkler, Eva C. 2005. The ethics of policy writing: How should hospitals deal with moral disagreement about controversial medical practices? Journal of Medical Ethics 31 (10): 559–566.

  • Winkler, Eva C., Gian Domenico Borasio, Peter Jacobs, Jürgen Weber, and Ralf J. Jox. 2012. Münchner Leitlinie zu Entscheidungen am Lebensende. Ethik in der Medizin 24 (3): 221–234.

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The authors thank the members of the USB Ethics Advisory Board for contributing to the Policy. Dr. Wiebke Paulsen, MA, has made valuable contributions to the algorithm. For their helpful support the authors thank Angelika Markaj, MSc, and Dr. Kristina Würth, lic. Phil.

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Correspondence to Charlotte Wetterauer .

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Wetterauer, C., Schürmann, J., Reiter-Theil, S. (2022). The Significance of Professional Codes and Ethical Guidelines in Difficult Clinical Situations. In: Laas, K., Davis, M., Hildt, E. (eds) Codes of Ethics and Ethical Guidelines. The International Library of Ethics, Law and Technology, vol 23. Springer, Cham.

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