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Review
. 2025 Aug 1;41(8):661-666.
doi: 10.1097/PEC.0000000000003423. Epub 2025 Jul 31.

Ethics in the Emergency Department: Withholding or Terminating Resuscitation

Joseph Shapiro  1   2 , Chidimma Acholonu  3   4 , Vanessa Madrigal  5   6
Affiliations
Review

Ethics in the Emergency Department: Withholding or Terminating Resuscitation

Joseph Shapiro et al. Pediatr Emerg Care. .

Abstract

Terminating cardiopulmonary resuscitation (ToR) in pediatric emergency department settings requires complicated clinical and ethical decision-making. This review focuses on providing physicians and advanced practice providers with practical guidance for assessing indicators of prognosis and navigating ethical considerations during the resuscitation of pediatric patients. Clinical indicators such as physical exam findings, arrest etiology, cardiopulmonary resuscitation (CPR) duration, and end-tidal carbon dioxide levels serve as benchmarks to guide resuscitation efforts. Ethical principles, including beneficence and non-maleficence, are critical in balancing the potential benefits of resuscitation with the harms of prolonged CPR, such as dysthanasia, moral distress, and adverse neurological outcomes. Underscored is the importance of compassionate communication with families, the appropriateness of clinician directiveness in ToR decisions, and the role of "slow codes" in the emergency department setting.

Keywords: cardiac arrest; ethics; moral distress; pediatric emergency; resuscitation.

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References

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