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 Ethical issues of cardiopulmonary resuscitation: current practice among emergency  physicians Marco CA; Bessman ES; Schoenfeld CN; Kelen GDAcad Emerg Med  1997[Sep]; 4 (9): 898-904OBJECTIVE: To determine current practice and attitudes among emergency physicians  (EPs) regarding the initiation and termination of CPR. METHODS: An anonymous  survey was mailed to randomly selected EPs. Main outcome measures included  respondents' answers to questions regarding outcome of resuscitation, and current  practice regarding initiation, continuation, and termination of resuscitation for  victims of cardiopulmonary arrest. RESULTS: The 1,252 respondents were from all  50 states, a variety of practice settings, and varying board certification. Most  (78%) respondents honor legal advance directives regarding resuscitation. Few  (7%) follow unofficial documents, or verbal reports of advance directives (6%).  Many (62%) make decisions regarding resuscitation because of fear of litigation  or criticism. A majority (55%) have recently attempted numerous resuscitations  despite expectations that such efforts would be futile. Most respondents  indicated that ideally, legal concerns should not influence physician practice  regarding resuscitation (78%), but that in the current environment, legal  concerns do influence practice (94%). CONCLUSIONS: Most EPs attempt to  resuscitate patients in cardiopulmonary arrest, regardless of futility, except in  cases where a legal advance directive is available. Many EPs' decisions regarding  resuscitation are based on concerns of litigation and criticism, rather than  their professional judgment of medical benefit or futility. Compliance with  patients' wishes regarding resuscitation is low unless a legal advance directive  is present. Possible solutions to these problems may include standardized  guidelines for the initiation and termination of CPR, tort reform, and additional  public education regarding resuscitation and advance directives.|*Ethics, Medical[MESH]|*Health Knowledge, Attitudes, Practice[MESH]|*Medical Futility[MESH]|Advance Directive Adherence[MESH]|Advance Directives/legislation & jurisprudence[MESH]|Attitude to Health[MESH]|Cardiopulmonary Resuscitation/standards/*statistics & numerical data[MESH]|Data Collection[MESH]|Emergency Medicine/legislation & jurisprudence/*standards[MESH]|Emergency Service, Hospital/legislation & jurisprudence[MESH]|Health Care Surveys[MESH]|Heart Arrest/*therapy[MESH]|Humans[MESH]|Practice Patterns, Physicians'/legislation & jurisprudence/*statistics &  numerical data[MESH]|Random Allocation[MESH]|Surveys and Questionnaires[MESH]|Treatment Outcome[MESH]|United States[MESH]
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