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Life support comprises the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic and advanced life support procedures; however, basic life support is sometimes provided at the scene of an emergency by family members or bystanders before emergency services arrive. In the case of cardiac injuries, cardiopulmonary resuscitation is initiated by bystanders or family members 25% of the time. Basic life support techniques, such as performing CPR on a victim of cardiac arrest, can double or even triple that patient's chance of survival.What is CPR Internet. 2013. American heart association; cited. Available from: http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/What-is-CPR_UCM_001120_SubHomePage.jsp Other types of basic life support include relief from choking (which can be done by using the Heimlich maneuver), staunching of bleeding by direct compression and elevation above the heart (and if necessary, pressure on arterial pressure points and the use of a manufactured or improvised tourniquet), first aid, and the use of an automated external defibrillator.
The purpose of basic life support (abbreviated BLS) is to save lives in a variety of different situations that require immediate attention. These situations can include, but are not limited to, cardiac arrest, stroke, drowning, choking, accidental injuries, violence, severe allergic reactions, , hypothermia, birth complications, drug overdose, and alcohol intoxication. The most common emergency that requires BLS is cerebral hypoxia, a shortage of oxygen to the brain due to heart or respiratory failure. A victim of cerebral hypoxia may die within 8–10 minutes without basic life support procedures. BLS is the lowest level of emergency care, followed by advanced life support and critical care. Alic M. 2013. Basic life support (BLS) Internet. 3rd. Detroit (MI):Gale; 2013, Available from: http://go.galegroup.com/ps/i.do?id=GALE%7CCX2760400129&v=2.1&u=csumb_main&it=r&p=GVRL&sw=w&asid=40d96ff26746d55939f14dbf57297410
Patients and family members who wish to limit the treatment provided to the patient may complete a do not resuscitate (DNR) or intubate (DNI) order with their doctor. These orders state that the patient does not wish to receive these forms of life support. Generally, DNRs and DNIs are justified for patients who might not benefit from CPR, who would result in permanent damage from CPR or patients who have a poor quality of life prior to CPR or intubation and do not wish to prolong the dying process.
Another type of life support that presents ethical arguments is the placement of a feeding tube. Decisions about hydration and nutrition are generally the most ethically challenging when it comes to end-of-life care. In 1990, the US Supreme Court ruled that Feeding tube and hydration are not different from other life-supporting treatments. Because of this, artificial nutrition and hydration can be refused by a patient or their family. A person cannot live without food and water, and because of this, it has been argued that withholding food and water is similar to the act of killing the patient or even allowing the person to die.Abbot-Penny A, Bartels P, Paul B, Rawles L, Ward A 2005. End of Life Care: An Ethical Overview. Ethical Challenges in End of Life Care. Internet. cited. Available from: www.ahc.umn.edu/img/assets/26104/End_of_Life.pdf life support bioethics This type of voluntary death is referred to as passive euthanasia.Beauchamp, Tom L., LeRoy Walters, Jefferey P. Kahn, and Anna C. Mastroianni. "Death and Dying." Contemporary Issues in Bioethics. Wadsworth: Cengage Learning, 2008. 402. Web. 9 Nov. 2013.
In addition to patients and their families, doctors also are confronted with ethical questions. In addition to patient life, doctors have to consider medical resource allocations. They have to decide whether one patient is a worthwhile investment of limited resources versus another. Current ethical guidelines are vague since they center on moral issues of ending medical care but disregard discrepancies between those who understand possible treatments and how the patient's wishes are understood and integrated into the final decision. Physicians often ignore treatments they deem ineffective, causing them to make more decisions without consulting the patient or representatives. However, when they decide against medical treatment, they must keep the patient or representatives informed even if they discourage continued life support. Whether the physician decides to continue to terminate life support therapy depends on their own ethical beliefs. These beliefs concern the patient's independence, consent, and the efficacy and value of continued life support. In a prospective study conducted by T J Predergast and J M Luce from 1987 to 1993, when physicians recommended withholding or withdrawing life support, 90% of the patients agreed to the suggestion and only 4% refused. When the patient disagreed with the physician, the doctor complied and continued support with one exception. If the doctor believed the patient was hopelessly ill, they did not fulfill the surrogate's request for resuscitation. In a survey conducted by Jean-Louis Vincent MD, PhD in 1999, it was found that of European intensivists working in the Intensive Care Unit, 93% of physicians occasionally withhold treatment from those they considered hopeless. Withdrawal of treatment was less common. For these patients, 40% of the physicians gave large doses of drugs until the patient died. All of the physicians were members of the European Society of Intensive Care Medicine.
In the case law to date in 1988, the courts decided that a decision to withhold or withdraw treatment was only for the physician to make, not the courts. However, the Manitoba court decided that given the scarcity of related cases and how none of them considered the Canadian Charter of Rights and Freedoms, it would try the case. Previous courts had held that physicians should not be bound by law to provide treatment that they did not believe the patient would want. Otherwise, the physician would be acting against his conscience and his duty as a physician. However, if the patient disagreed, they can sue the physician for negligence. To avoid this, Justice Beard ruled in favor of the patient. Resuscitation is not controversial and only requires CPR, which would be performed by the first qualified person on the scene. Even if resuscitation was an ethical dilemma, it was minor given that the doctor had allowed resuscitation for several months already. In contrast with related cases in which patients were comatose, Mrs. Sawatzky provided evidence that her husband was able to communicate and believed that he could recover, but the doctor disagreed. The uncertainty of recovery pushed the Court to order the physician to allow resuscitation. Where rulings discuss end of life issues, the question is more, "Is continued life a benefit to this person" instead of, "Is it possible to treat this person". These questions are beyond the scope of the medical profession and can be answered philosophically or religiously, which is also what builds our sense of justice. Both philosophy and religion value life as a basic right for humans, rather than as the ability to contribute to society, and purposely encompasses all people. Mr. Sawatzky fell under the umbrella, so the judge ruled in his favor.
These techniques are applied most commonly in the Emergency Department, Intensive Care Unit and . As various life support technologies have improved and evolved they are used increasingly outside of the hospital environment. For example, a patient who requires a ventilator for survival is commonly discharged home with these devices. Another example includes the now-ubiquitous presence of automated external defibrillators in public venues which allow lay people to deliver life support in a prehospital environment.
The ultimate goals of life support depend on the specific patient situation. Typically, life support is used to sustain life while the underlying injury or illness is being treated or evaluated for prognosis. Life support techniques may also be used indefinitely if the underlying medical condition cannot be corrected, but a reasonable quality of life can still be expected.
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