The ethical and clinical conflict of cardiopulmonary resuscitation (CPR) in the emergency department: futile interventions

OBJECTIVE: Scientific and technological advancements have significantly contributed to increased life expectancy; however, unresolved debates persist regarding quality of life and the dying process. Cardiopulmonary resuscitation (CPR) performed on terminal patients in the emergency department remains a subject of clinical and ethical controversy. This study aims to evaluate the ethical conflicts faced by physicians when making decisions about potentially futile treatments in emergency settings. MATERIALS AND METHODS: This study was conducted in the emergency department of a university hospital in Türkiye and consisted of two phases. In the first phase, 118 cardiac arrest cases were analyzed among 446,397 patients who presented to the emergency department between 2020 and 2025. In the second phase, emergency physicians were surveyed regarding their decisions to initiate or terminate CPR. RESULTS: According to the findings, the average age of patients who responded to CPR was 65.54 ± 13.49, whereas non-responders were significantly older. Although the majority of physicians believed that discontinuing CPR is ethically inappropriate, 98% were able to accurately predict cases in which CPR would be futile. Among physicians who refrained from terminating CPR despite anticipating non-responsiveness, the most frequently cited reasons included "concerns over legal, ethical, and professional responsibilities" (79.3%), followed by "social pressure (risk of violence or complaints)" (75.9%), and "noncompliance with religious and cultural beliefs" (69%, n = 20). CONCLUSION: Physicians' reluctance to terminate futile treatment is influenced by legal and ethical responsibilities, social pressures, religious beliefs, and empathy. The study highlights the ethical and clinical conflicts faced by physicians in decisions regarding futile CPR and emphasizes the need for multidisciplinary approaches and ethical guidelines in such cases. Additionally, providing family members with clear information about the likely outcomes of CPR may facilitate ethical decision-making.