Family Presence During Resuscitation: Extending Ethical Norms from Pediatrics to Adults

Guest Post: Christine Vincent and Zohar Lederman

Paper: Family presence during resuscitation: extending ethical norms from paediatrics to adults

Family Presence During Resuscitation is an important ethical issue for discussion within the medical community. Currently, family presence is more commonly accepted in paediatric cardiopulmonary resuscitation (CPR) than adult CPR. However, we argue that this fact is not morally justified and that the case for family presence during adult CPR is indeed morally stronger. In our paper we provide an ethical argument for accepting both family presence during adult CPR and pediatric CPR.

Arguments commonly used by ethicists and medical professionals to justify family presence during resuscitation (FPDR) in the emergency room revolve around scarce evidence of harm to patient outcome, strong evidence demonstrating benefits to relatives, and respect for patient’s wishes. However, we argue that these three main reasons all seem to be stronger in the case of adult patients than pediatric ones.

Evidence demonstrating no negative effects of FPDR on patient outcome has mainly been found for adult patients. Furthermore, research showing benefits to relatives from being present is much stronger for adult patients as well. Lastly, the wishes and rights of adults are commonly much more respected compared to those of children, both in healthcare and generally. There is no reason why this should not extend to FPDR as well, given that the majority of patients prefer to go through traumatic life events surrounded by friends and family.

In our conclusion, we mention how family presence during any patient’s resuscitation is a huge step from where society was decades ago. In the future, it is important that we put into place protocols that include FPDR as  default, but also allow for cases when this procedure cannot occur. Further research is needed to look into why health care providers are more ready to accept family presence during pediatric resuscitation but not during adult resuscitation. Do they find a way rationalize it or is it just gut instinct? The disagreement between this view of healthcare providers on one hand and family members on the other hand, who typically all wish to be present, needs to be addressed. Action needs to be taken within hospitals, and context-specific policies should be drafted by local professionals and community members to guide and facilitate FPDR as standard practice.

Pushing the envelope, one may wonder about the implication of following the argument where it leads. If family presence during CPR is justified because it respects patients’ wishes, benefits relatives, and does not negatively affect patient outcome, could family presence during surgeries be justified as well? What really is the morally significant difference between CPR and surgery? The potential risk to relatives? The potential risk to patients (e.g. infections)? These are consequentialist concerns, and as such they may be tested empirically. But even if these concerns turn out to be substantiated, should they justify overriding the wishes of patients and relatives?

Some topics in bioethics are extremely contentious and are unlikely to be resolved in practice anytime soon, e.g. abortion, infanticide, euthanasia. FPDR seems to be a much simpler issue to resolve and implement.

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