Ethical Guidance on the Use of Life-Sustaining Therapies for Patients With Ebola in Developed Countries
Authors: Scott D. Halpern, Ezekiel J. Emanuel
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions17 February 2015Ethical Guidance on the Use of Life-Sustaining Therapies for Patients With Ebola in Developed CountriesScott D. Halpern, MD, PhD and Ezekiel J. Emanuel, MD, PhDScott D. Halpern, MD, PhDFrom the Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author and Ezekiel J. Emanuel, MD, PhDFrom the Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2611 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Consider 4 patients with Ebola virus disease who require care in hospitals in developed countries. Patient A has rapidly progressive hypovolemic shock that evolves into pulseless electrical activity. The cardiac arrest is noted from the telemetry monitor at the nurses' station. Should a code be called?Patient B develops profound hypokalemia from diarrhea. While 2 nurses and a physician in protective equipment are at the bedside, the patient develops ventricular fibrillation. Should the clinicians attempt electrical defibrillation while using an indwelling intravenous catheter to correct the hypokalemia?Patient C has progressive Ebola with shock and multisystem organ failure. He becomes ...References1. Halpern SD, Ubel PA, Asch DA. Harnessing the power of default options to improve health care. N Engl J Med. 2007;357:1340-4. [PMID: 17898105] CrossrefMedlineGoogle Scholar2. Fowler RA, Fletcher T, Fischer WA, Lamontagne F, Jacob S, Brett-Major D, et al. Caring for critically ill patients with ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014;190:733-7. [PMID: 25166884] doi:10.1164/rccm.201408-1514CP CrossrefMedlineGoogle Scholar3. Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, et al; ProCESS Investigators. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370:1683-93. [PMID: 24635773] doi:10.1056/NEJMoa1401602 CrossrefMedlineGoogle Scholar4. Emanuel EJ. Do physicians have an obligation to treat patients with AIDS? N Engl J Med. 1988;318:1686-90. [PMID: 3374540] CrossrefMedlineGoogle Scholar5. Young MJ, Brown SE, Truog RD, Halpern SD. Rationing in the intensive care unit: to disclose or disguise? Crit Care Med. 2012;40:261-6. [PMID: 21926611] doi:10.1097/CCM.0b013e31822d750d CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.Financial Support: Dr. Halpern was supported by a Greenwall Foundation Faculty Scholar Award in Bioethics.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2611.Corresponding Author: Scott D. Halpern, MD, PhD, University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; e-mail, [email protected]upenn.edu.Current Author Addresses: Dr. Halpern: University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.Dr. Emanuel: Department of Medical Ethics and Health Policy, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA 19104.Author Contributions: Conception and design: S.D. Halpern, E.J. Emanuel.Drafting of the article: S.D. Halpern, E.J. Emanuel.Critical revision of the article for important intellectual content: S.D. Halpern, E.J. Emanuel.Final approval of the article: S.D. Halpern, E.J. Emanuel.Administrative, technical, or logistic support: S.D. Halpern, E.J. Emanuel.This article was published online first at www.annals.org on 30 December 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUse of Life-Sustaining Therapies for Patients With Ebola Virus Disease Jeffrey T. Berger Use of Life-Sustaining Therapies for Patients With Ebola Virus Disease Scott D. Halpern and Ezekiel J. Emanuel Use of Life-Sustaining Therapies for Patients With Ebola Virus Disease Jeffrey T. Berger Use of Life-Sustaining Therapies for Patients With Ebola Virus Disease Scott D. Halpern and Ezekiel J. Emanuel Metrics Cited ByEthics of Outbreaks Position Statement. Part 1Biocontainment Principles for Pediatric PatientsTransportation of Patients in a BioemergencyEbola virus disease and critical illnessTranslating Professional Obligations to Care for Patients With Ebola Virus Disease Into Practice in Nonepidemic SettingsEbola Virus DiseaseEbola virus diseaseUse of Life-Sustaining Therapies for Patients With Ebola Virus DiseaseJeffrey T. Berger, MDCritical Care Management of Two Patients With EbolaEthical and Practical Considerations in Providing Critical Care to Patients With Ebola Virus Disease 17 February 2015Volume 162, Issue 4Page: 304-305KeywordsBioethicsDecision makingHealth care providersHeartIntensive care unitsResuscitation ePublished: 17 February 2015 Issue Published: 17 February 2015 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...