Evolution of medical ethics in resuscitation and end of life

Medical ethics has evolved from paternalistic to patient-centred. Emergency and end-of-life situations are frequently associated with inability to make informed decisions. Respect for advance directives, proxy informed consent for therapeutic/research interventions, do-not-attempt resuscitation orders, and withdrawal of life-sustaining treatment focus on autonomy and nonmaleficence. Beneficence is increasingly interpreted in terms of “achieved quality of life” following emergency treatment/resuscitation. Justice pertains to equality of access to best available care, which depends on patient age, comorbidity, preferences, socioeconomic status, race, ethnicity, and religion. Dignity includes the concept of “dignified death;” the still-debated practice of physician-assisted death is gaining ground. Honesty/transparency augments patient participation in shared decision-making and treatment selection. A still-prominent, international variation in bioethical principles interpretation mandates continuous effort for harmonization.