Emergency medical providers often care for patients in cardiac arrest, and numerous ethical dilemmas may be encountered, including conflicting family opinions, unreasonable requests by bystanders, lack of availability of advance directives, and others. Protocols regarding the withholding of resuscitative efforts vary widely among states and emergency medical services (EMS) jurisdictions within states. Such protocols should address many issues including justification, specificity, patient participation, inclusion of minors, futility, portability, utilization of health care resources, and responsibility for pronouncing death.