The CPR Dilemma

Throughout various forms of media, but especially in cartoons/animations: the depiction of someone collapsing suddenly and another character rushing to blow into their mouths and push on their chest is quite common. Typically, this simple sequence of events results in a quick, heroic revival. However, the truth is that CPR—cardiopulmonary resuscitation—is not nearly that simple. While almost 65% of Americans claim that they have received CPR training at some point in their lives(1), when it comes time to put those skills into practice, a large portion of these individuals simply don’t. 

Why? As found in multiple studies, in terms of out-of-hospital cardiac arrests, bystanders often face barriers to initiating CPR(2). As per the study, some bystanders described the attempt as “uncomfortable and shocking,” and others feeling simply lost and powerless. Individuals may often have concerns surrounding the ethics of CPR, and whether their attempt at CPR could result in consequences instead, leading to a completely hands-off approach. However, it is critical for the general public to know about two things: the call-push-shock protocol, and the Good Samaritan Laws in order to alleviate these concerns. 

The call-push-shock protocol is a procedure created by the National Sudden Cardiac Arrest foundation which surrounds the totality of steps bystanders should take if ever witnessing an instance of sudden cardiac arrest. Essentially, the steps include first calling 911, then immediately beginning CPR compressions, and finally using an AED (automated external defibrillator) in order to shock the heart back into its original rhythm(3). CPR alone isn’t enough to save a life—it’s CPR coupled with these other steps which can greatly increase one's chance of survival. 

The Good Samaritan Laws vary by state, but aim to protect any individual who attempts to help a person in emergency situations(4). As a result, it is critical for everyone to know that they will not be blamed or punished for whatever the outcome may be in a cardiac arrest situation; instead they will be appreciated for at least attempting to help in any way (e.g CPR, calling 911 etc). This is especially relevant considering that the “mortality rate increases 3% for each minute without CPR and 4% for each minute without defibrillation.” Further, it is important to note that new guidelines place a greater emphasis on constant chest compressions in place of giving breaths that may be administered wrong and hence do not need implementation. 

Clearly, dealing with CPR and bystander responses are ethically and morally complex situations that require increased attention and education in order to save lives. However, it is not just complex from a bystander, out-of-hospital standpoint: there is a whole other set of debates when it comes to in-hospital cardiac arrests. Many times, there exist conflicts of interests between doctors, patients, and families. In terms of cardiac arrests in hospitals, universal consent is implied. However, this may result in controversy, as the patient's caregivers may not want to give consent for doctors to do anything to them. Further, some patients may be resuscitated, but not have actually wanted said revival(5).

As a response to these controversial instances, some ethicists have begun to argue that not everyone in cardiac arrest should be given CPR, and that it should only be given to those who are likely to benefit. For example, if a patient has signs of irreversible death, loss of vital functions, or a DNAR order, some people argue that they should be left alone and that CPR should not be attempted at all. Patients and families often feel that individuals should not be “forced” back into life, a very controversial concept. 

To conclude, cardiac arrest is a fatal, relatively common incident that occurs both in and out of hospitals. CPR is one of the only solutions to it, but is surrounded by a cloud of ethical concerns that must be widely addressed. 

Reviewed by Catie Fristoe

Design by Ariha Mehta

References

1)Bendix, A. (2023, January 4). Doctors call on more people to learn CPR after damar

Hamlin's cardiac arrest. NBC News.https://www.nbcnews.com/health/health-news/

doctors-call-people-learn-cpr-damar-hamins-cardiac-arrest-rcna64242#:~:text=While%

065%25%20of%20people%20in,the%2population%2C%22%20said%20Dr

2)Call-push-Shock. (2020). Sudden Cardiac Arrest Foundation.

https://www.sca-aware.org/call-push-shock

3)Hansen et al., C. (2017, March 13). Lay bystanders' perspectives on what facilitates

cardiopulmonary resuscitation and use of automated external defibrillators in real

cardiac arrests. PubMed Central (PMC).https://www.ncbi.nlm.nih.gov/pmc/

articles/PMC5524003/

4)Rubulotta, F. (2013, October). Cardiopulmonary resuscitation and ethics. PubMed Central

(PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031875/

5)West, B. (2022, September 12). Good samaritan laws - StatPearls - NCBI bookshelf. National

Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/

NBK542176/

The Hidden Moral Dilemma of Physician-Assisted Suicide: Exploring Emotional and Psychological Dimensions in Euthanasia Procedures for Participating Physicians

Since the emergence of human existence, global healthcare institutions have been tailored to the community and geographic area in which they have served. Despite this cultural diversity, one role has remained unchanged: the physician’s responsibility to do no harm and save lives at all costs. With the increasing popularity of medical aid in dying (MAiD), the purpose of physicians has shifted away from these fundamental values of medicine to heal and promote human well being (1). This change not only discourages entrance into medical fields, but threatens adverse effects for physicians being forced into these complex ethical situations. Kenneth Stevens, Professor in Radiation Oncology at the University of Oregon, cites the feelings of physicians asked to aid in this process as “suddenness, powerlessness, and isolation” (1). These effects are further exacerbated in cases of pressure on and intimidation of doctors, which presents them with a moral conflict between their personal belief and duty in their occupation. In a study conducted to examine physician attitudes versus willingness to perform euthanasia-related procedures, only 13% of physicians who thought the practice should be legalized or decriminalized reported that they would be unequivocally willing to perform it themselves (3). These results suggest a large discrepancy between endorsement and practice of MAiD that is a result of a conflict of duties: “the duty to preserve life on one hand and the duty to relieve suffering on the other hand” (2). 

In evaluating the risks of MAiD, we must then factor into the conversation the risk of emotional burdens for the participating physician associated with preparing and performing these procedures on their patients. Mainly, dealing with death on a constant basis in addition to handling these challenging situations can have significant impacts on clinician health, causing feelings of self doubt, intense memories, and disconnection from patients. The direct effect of such feelings may be burnout and depression, which would reduce the ability of physicians to communicate and empathize with patients and families in times of great need (4). The implementation of MAiD also lowers boundaries between professional and personal life for physicians, which can consequently lead them to internalize feelings of their patients and question their own mortality. 

Although we may have not fully accepted the integration of MAiD into our healthcare systems, it is important to address concerns about undermining the role of the physician and provide necessary support that is needed to adjust to significant change within our medical systems.

Designed By: Angie Huang

Edited By: Katherine Hinton

Works Cited:

1. Stevens, Kenneth R. “Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia on Participating Physicians.” Issues in Law & Medicine, vol. 21, no. 3, 2006, pp. 187–200, pubmed.ncbi.nlm.nih.gov/16676767/.

2. Evenblij, Kirsten, et al. “Physicians’ Experiences with Euthanasia: A Cross-Sectional Survey amongst a Random Sample of Dutch Physicians to Explore Their Concerns, Feelings and Pressure.” BMC Family Practice, vol. 20, no. 1, 17 Dec. 2019, bmcprimcare.biomedcentral.com/articles/10.1186/s12875-019-1067-8, https://doi.org/10.1186/s12875-019-1067-8.

3. Hetzler, Peter T., et al. “A Report of Physicians’ Beliefs about Physician-Assisted Suicide: A National Study.” The Yale Journal of Biology and Medicine, vol. 92, no. 4, 20 Dec. 2019, pp. 575–585, www.ncbi.nlm.nih.gov/pmc/articles/PMC6913834/.

4. Siden, Harold. “Physician Stress in the Context of Medical Aid in Dying.” UBC Medical Journal, 2016, med-fom-ubcmj.sites.olt.ubc.ca/files/2017/03/v8i1-feature2.pdf.

Increasing The Maximum Lifespan of Humans

The age-old question of how to cheat death has vexed humans for centuries. However, modern day science has shed light on the possibilities of increasing the maximum lifespan. The general consensus among Americans today is that longevity comes from exercise, a healthy diet, and practicing good self-care. Scientific evidence supports the notion that physical activity contributes to increased longevity [4], and a nutritious diet is associated with a remarkable 20% decrease in mortality [5]. While these facts are widely known, the intriguing prospect arises – could newly-developed pharmaceuticals pave the way for individuals to surpass the centenarian mark (living past 100)?

Enter Rapamycin, an immunosuppressant drug for cancer and kidney transplant treatments recently approved by the FDA. Studies on mice revealed that Rapamycin could extend their lifespan by up to 60%, accompanied by improvements in muscle strength and motor coordination [1]. Notably, this drug has consistently demonstrated its longevity-enhancing effects across various model organisms, including yeast, worms, and flies [2]. However, some caution is advised, as the potential side effects include infection, the development of lymphoma, high blood pressure, high cholesterol levels, mouth ulcers, and the loss of kidney function [3]. Some sources speculate whether certain side effects are influenced by other factors [2]. 

Yet one main issue revolving around drugs that increase longevity is that it is difficult to accurately measure their effects in humans as there are so many factors at play. Such studies would likely have to involve many subjects and last entire lifespans [3]. Instead, there currently is a crucial clinical trial of the drug’s effects on man's best friend: dogs [6]. Overall, this fascinating drug shows great promise, underscoring the need for further research to unravel its secrets and weigh the delicate balance between its benefits and potential side effects.

Edited By: Eric Wang

Designed By: Heiley Tai

Citations:

[1] Bitto, A., Ito, T. K., Pineda, V. V., LeTexier, N. J., Huang, H. Z., Sutlief, E., Tung, H., Vizzini, N., Chen, B., Smith, K., Meza, D., Yajima, M., Beyer, R. P., Kerr, K. F., Davis, D. J., Gillespie, C. H., Snyder, J. M., Treuting, P. M., & Kaeberlein, M. (2016). Transient rapamycin treatment can increase lifespan and healthspan in middle-aged mice. eLife, 5, e16351. https://doi.org/10.7554/eLife.16351

[2] Blagosklonny M. V. (2023). Towards disease-oriented dosing of rapamycin for longevity: does aging exist or only age-related diseases?. Aging, 15(14), 6632–6640. https://doi.org/10.18632/aging.204920

[3] ​​Janin, A. (2023, May 1). Can a Kidney Transplant Drug Keep You From Aging? The Wall Street Journal.

[4] Reimers, C. D., Knapp, G., & Reimers, A. K. (2012). Does physical activity increase life expectancy? A review of the literature. Journal of aging research, 2012, 243958. https://doi.org/10.1155/2012/24395

[5] Lubell, J. (2023, February 16). Diet patterns that can boost longevity, cut chronic disease | American Medical Association. American Medical Association; AMA. https://www.ama-assn.org/delivering-care/public-health/diet-patterns-can-boost-longevity-cut-chronic-disease#:~:text=Across%20the%20board%2C%20all%20healthy,white%20people%2C%20the%20study%20says

[6] Anthes, E. (2023). Could a Drug Give Your Pet More Dog Years? The New York Times.