ETHICAL DILEMMAS IN DECISION-MAKING IN OUT-OF-HOSPITAL CARDIAC ARREST: IMPLICATIONS FOR NURSES IN IMMEDIATE LIFE SUPPORT
DOI:
https://doi.org/10.63176/3b5hjf26Keywords:
Out-of-Hospital Cardiac Arrest, Ethics, Decision-Making, Cardiopulmonary Resuscitation, Nursing, Immediate Life SupportAbstract
Introduction: Out-of-hospital cardiac arrest involves complex clinical decisions, often made with limited information and in the presence of ethical challenges related to proportionality of treatment, autonomy, dignity, and the person’s previously expressed wishes.
Objectives: To analyse the ethical dilemmas associated with decisions to initiate, continue, or terminate cardiopulmonary resuscitation in the out-of-hospital setting and to discuss their implications for nurses working in Immediate Life Support teams.
Methods: Narrative literature review based on searches of CINAHL, MEDLINE/PubMed, and SciELO. Studies addressing decision-making, ethical dilemmas, proportionality of treatment, do-not-resuscitate decisions, and termination of resuscitation were included. Following the selection process, 21 articles were included in the review, supplemented by Portuguese legislation, regulatory documents, and professional guidance.
Results: The main dilemmas concern decisions to initiate, continue, or terminate resuscitation, patient autonomy, advance directives, dignity, and family presence. Termination of Resuscitation rules may be useful in supporting decision-making but do not replace clinical judgement. Among nurses working in Immediate Life Support teams, limited participation in decision-making may generate tension between clinical responsibility, ethical principles, and professional autonomy.
Conclusions: Decision-making in out-of-hospital cardiac arrest should integrate clinical evidence, ethical principles, proportionality, and the person’s values. Structured models that strengthen nurses’ participation in decision-making should be evaluated while maintaining coordination with medical regulation and ensuring the safety of care.
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Copyright (c) 2026 Pedro Vasconcelos, Ana Carvalho, Diogo Gonçalves, Marco Sousa, Abílio Teixeira (Autor)
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