Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;272(6):930-934.
doi: 10.1097/SLA.0000000000004318.

Ethics of Codes and Codes of Ethics: When Is It Ethical to Provide Cardiopulmonary Resuscitation During the COVID-19 Pandemic?

Piroska K Kopar  1 , Douglas E Brown, Isaiah R Turnbull
Affiliations

Ethics of Codes and Codes of Ethics: When Is It Ethical to Provide Cardiopulmonary Resuscitation During the COVID-19 Pandemic?

Piroska K Kopar et al. Ann Surg. 2020 Dec.

Abstract

Objective: Our study aims to provide a paradigm when it is ethical to perform cardiopulmonary resuscitation (CPR) on patients during the COVID-19 pandemic.

Summary background data: Hospitals around the nation are enacting systems to limit CPR in caring for COVID+ patients for a variety of legitimate reasons and based on concepts of medical futility and allocation of scarce resources. No ethical framework, however, has been proposed as a standard to guide care in this crucial matter.

Methods: Our analysis begins with definitions of ethically relevant terms. We then cycle an illustrative clinical vignette through the mathematically permissible possibilities to account for all conceivable scenarios. Scenarios with ethical tension are examined.

Results: Patients have the negative right to refuse care including CPR, but they do not have the positive right to demand it. Our detailed ethical analysis and recommendations support CPR if and only if 1) CPR is judged medically beneficial, and in line with the patient's and values and goals, 2) allocations or scarce resources follow a just and transparent triage system, and 3) providers are protected from contracting the disease.

Conclusions: CPR is an intervention like any other, with attendant risks and benefits and with responsibility for the utilization of limited resources. Our ethical analysis advocates for a systematic approach to codes that respects the important ethical considerations in caring for the critically ill and facilitates patient-centered, evidence-based, and fair treatment to all.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Cha AE. Hospitals consider universal do-not-resuscitate orders for coronavirus patients. The Washington Post 2020.
    1. Corley J. Doctors in Training are Dying, and We are Letting Them Down. In. Forbes 2020.
    1. Daniels LM, Johnson AB, Cornelius PJ, et al. Improving quality of life in patients at risk for post-intensive care syndrome. Mayo Clin Proc Innov Qual Outcomes 2018; 2:359–369. - PMC - PubMed
    1. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020; 382:2049–2055. - PubMed
    1. Kopar PK, Lui F. Surgeon as double agent: surgeon perceptions of conflicting expectations of patient care and stewardship of resources. J Am Coll Surgeons 2019; 229:E18–E19. - PubMed