When to Let Go: Physician Ethical Dilemmas in CPR Initiation During In-Hospital Arrests
Keywords:
cardiopulmonary resuscitation, terminally ill, attitude of health personnel, linical decision-making, ethics, medical, CroatiaAbstract
Objective: To examine physicians' attitudes on initiating and terminating cardiopulmonary resuscitation (CPR) in terminally ill patients and to explore how these attitudes vary by demographic and professional characteristics.
Methods: This cross-sectional study included 129 medical specialists from 14 departments of the University Hospital Centre Osijek, Croatia (2021). Data were collected using a 31-item questionnaire covering demographics, professional experience, attitudes toward CPR, knowledge of survival outcomes, and responses to six clinical scenarios.
Results: More than half of respondents (55.1% and 69.8%, respectively) supported withholding or early termination of CPR in patients with incurable illness, primarily citing false hope, prolonged suffering, and resource overuse. Despite these views, over half indicated they would initiate CPR in all six hypothetical scenarios, including patients with advanced malignancy and multiple comorbidities. ICU admission following successful CPR was favoured by 52% of respondents, even in terminal cases, although knowledge of outcomes and resources was limited: only 45% correctly identified survival rates after in-hospital cardiac arrest, and fewer than 40% knew ICU bed capacity. Surgeons were less likely than non-surgeons to regard CPR in terminal patients as futile (P<0.05).
Conclusion: Our findings indicate that structured ethics education and clear institutional guidelines are essential to improve decision-making in end-of-life care in Croatia.
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