RESPOND:Resuscitation Ethics – Paramedic Onsite Decisions

This thesis examines some of the ethical issues around paramedic decisions to commence or forego resuscitation in cardiac arrest.Utilising empirical methodology, paramedics were asked about their resuscitation decision-making to help understand on what (ethical) basis these decisions are – and should be – made. 14 semi-structured interviews with paramedics were conducted, which were then thematically analysed. A narrative literature search explored previous research into this topic, including ethical, legal and empirical studies. Taking an empirical bioethics approach, ‘reflexive balancing’ was then used to synthesise the results from the literature search and the interviews into normative recommendations.Three main themes were developed from the empirical findings: ‘Between the gut and the guideline’; ‘Assumptions, wishes and tolerable outcomes’; and, ‘Finding dignity in the face of brutality’. These covered topics around the act of decision-making, difficulties in understanding a patient’s wishes in situations lacking time and information, and the effects of resuscitation on patients, their families, clinicians and society.From analysing the themes, it was apparent that decision-making in cardiac arrest relies on a degree of clinical intuition, which is somewhat mitigated using guidelines, although never fully. Due to this, decisions are subject to a series of biases and also open to the effects of unconscious prejudice. The current use of the Mental Capacity Act 2005 and defining the critical concept of ‘best interests’ is fraught with difficulties, especially in hyper-acute scenarios like cardiac arrests. Knowing a patient’s wishes prior to arrival removes many of these issues. Dignity appears to be too nebulous a term to be of much use in defining what ought to happen in cardiac arrest.Decisions to commence or forego resuscitation are fraught with difficulty however, this thesis concludes with a series of normative recommendations which can (hopefully) make this process somewhat easier in future