Inducing death to give life – without patient consent
A new emergency procedure being trialled in a US hospital has bioethicists feeling nervous.
A new emergency procedure being trialled in a US hospital has bioethicists feeling nervous. The procedure – known as Emergency Preservation and Resuscitation – involves stopping the heart and lowering the body temperature of trauma patients experiencing cardiac arrest and severe blood loss.
Doctors replace the patient’s blood with freezing saltwater that stops the heart and lowers body temperature to 10 degrees Celsius. At this temperature doctors have one to two hours to operate before brain damage occurs.
The procedure stops rapid blood loss and dramatically slows the onset of brain damage. At normal body temperatures, surgeons typically have less than five minutes to restore blood flow before brain damage occurs.
Doctors – not the patients – will decide whether the procedure will be performed. Only patients who have obtained a hospital bracelet saying “No EPR” will be omitted from candidature. Some ethicists have expressed reservations about the lack of informed consent, but they recognize the difficulties of obtaining such patient approval.
Arthur Caplan of the Berman Bioethics Centre says the procedure will often be the only option to keep patients alive. He is, however, nervous about possible brain damage:
“If this works, what they’ve done is suspended people when they are dead and then brought them back to life…there’s a grave risk that they won’t bring the person back to cognitive life but in a vegetative state.”
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