An Ethical Analysis of the Use of 'Futility' in the 1992 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care

Abstract

IN AN earlier article¹we explored ethical decision making in the prehospital emergency setting with particular attention to emergency cardiac care (ECC). We argued in support of recent efforts to develop portable do-not-resuscitate (DNR) policies that allow patients' wishes to be honored outside the hospital setting, such as during interinstitutional transfer, in long-term care facilities, in the home, or elsewhere. We also proposed allowing emergency personnel to cease futile resuscitation in the field. We argued that unlike DNR orders, a judgment that resuscitation is futile should rest with qualified medical personnel and should reflect a professional consensus supported by sound empirical data. In this article, we examine the most recent American Heart Association (AHA)<i>Guidelines</i>for cardiopulmonary resuscitation (CPR) and ECC.²While we commend the new guidelines for acknowledging medical futility, we identify shortcomings in the definition of medical futility and suggest further revisions.