[Ethical aspects of resuscitation]

Abstract

The former typically paternalistic physician-patient relationship has changed gradually toward an autonomy based one in the second half of the 20th century. Patient's autonomy includes the right to refuse life-saving therapy in modern constitutional states. Hungarian law assures the right to refuse life-saving treatment as well. However to our knowledge no such therapy refusal has occurred since the law coming into force likely because of the rather strict regulations. Forgoing resuscitation is basically determined by two factors: autonomy of the patient, and medical futility. The alteration of the law's form can facilitate the lawful Do Not Resuscitate (DNR)orders for the sake of patient's autonomy. Qualitative futility is characterized by quality of life, which only the patient has the right to judge. Resuscitation protocols based on results of controlled studies can significantly improve both the success rate of resuscitations and the quality of life. Education plays a prominent role in this process as it was demonstrated in our prospective comparative study. According to author's study Hungarian DNR orders are paternalistic and patient autonomy plays a secondary role. It was also established that patient's autonomy significantly improved in the subgroup trained according to international standards. Hungarian results were compared to the results of a highly educated group in the second study. The results confirmed the presumption: the education of resuscitation according to international standards improves both the representation of patient's autonomy in DNR decisions, survival rate and quality of life.