Ethical Considerations in Trauma Resuscitation
Traditional ethical decision making in medical care balances the principles of patient autonomy, beneficence, nonmaleficence, and social justice to achieve an optimal patient-centered outcome.1 Interpreting the impact of each of these considerations for a given patient often necessarily relies on input from that patient to assure respect for autonomy. However, acute injuries may threaten a patient’s autonomous decision making because of unconsciousness, administration of sedating agents, possible brain injury, substance use, distracting injury, self-harm behaviors, or other factors. Further, the acuity of injury may demand intervention before it is possible for consultation with the patient or their surrogate decision maker. In the absence of representative patient input, the medical care team may be compelled to rely on substituted judgment for immediate care and resuscitation, considering what is believed to be in the patient’s best interest.