This edition of the journal includes, with an introduction and three commentaries, a recent joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing, on decisions relating to cardiopulmonary resuscitation (CPR).1 The statement was produced in response both to a professional need to decide when attempting CPR is and is not ethically appropriate, or indeed lawful (especially in the light of incorporation of the European Convention on Human Rights into UK law), and also (...) to public concern that such decisions have not always been made in concordance with the wishes of patients or people close to them. The guidelines it sets out reflect a broad consensus of current medicolegal views in the UK, include a variety of helpful and practical recommendations, and can be seen, in many respects, as a model of their kind. As a model of actual decision making however, they raise some problems. Model helps us understand the reality they represent by simplifying it, but in the process of simplification, aspects of the reality represented which do not fit in with the model may be left out or downplayed. Three such aspects identified by our commentators concern patient autonomy, quality of life judgments, and the role of families in decision making. In his commentary, Robin Gill argues that while “many of us cherish” the right to be properly informed before decisions about our treatment are made, such information “may become a burden for others when they are at their most vulnerable”. Being told about CPR, with the implication that a “do not attempt resuscitation” (DNAR) order is at least possible, may provoke “angst about death” in these vulnerable patients. The guidelines state that a competent patient's wish not to discuss resuscitation should be respected. But they also state that …. (shrink)

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they (...) have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)