Part 3: Ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

In this chapter, the American Heart Association provides guidance on ethical considerations relevant to cardiopulmonary resuscitation and emergency cardiovascular care. An overview is provided of ethical frameworks that provide a structure through which difficult decisions can be analyzed. These include principlism, currently the predominant medical ethical framework, which considers moral principles of beneficence, nonmaleficence, respect for autonomy, and justice. Additional consideration is given to the value of dignity, and other ethical frameworks such as narrative ethics, crisis standards of care, utilitarianism, virtue ethics, and deontology. The importance of equity and the imperative for health care professionals and their organizations to actively address structural inequities, social determinants of health and resulting disparities related to Emergency Cardiovascular Care is highlighted. Processes for decision-making are discussed, including guidance on advance directives and shared decision-making. Decisions to initiate or withhold and subsequently to continue or terminate resuscitation are reviewed at length. In addition to considering this decision in adults and geriatric patients, specific attention is given to decision-making in children, newborn infants, and pregnant patients. The impact of prognostic uncertainty on these decisions is discussed, as well as the evaluation of potentially ineffective therapies and cultural and religious considerations. Other ethical topics are addressed briefly, including processes for research and knowledge generation; the impact of resuscitation on health care professionals, survivors, laypersons, families, and caregivers; family presence during resuscitation; crisis standards of care; advanced therapies, including extracorporeal support; and organ and tissue donation.