Ethical Dilemma from Current Events
Family Presence During Resuscitation
Tracy Sitek
Grand Canyon University
Ethical Decision Making in Healthcare
NRS 437V
Barbara Trabelsi
April 17, 2011
Ethical Dilemma from Current Events
Over the last decade, controversy over family presence during resuscitation (FPDR) and invasive procedures has markedly increased. Historically, it has always been thought that having a family member that was hysterical or asking questions for clearer understanding of the situation was a deterrent or distraction for the staff while they were trying to provide care to their critically ill relative. No one wanted the family in the room as they might ...view middle of the document...
It could be argued that this approach is best for the staff, and may or may not be best for the patient and the family. Yes, evolution is slow, but it holds promise for the future.
In the case of a 62 year old man that reluctantly presented to the emergency department after four days of searing low back pain and new onset of vomiting, another type of ethical dilemma began. This patient was alert and oriented and discussed his known advanced cardiac disease and that his relatively small abdominal aortic aneurysm was being watched but was not yet operative. Waving goodbye to his wife and daughter, he was quickly taken to the radiology department for an abdominal CT to rule out an aortic dissection. The family was waiting nearby CT when the code blue tones began to sound overhead. Unresponsive and in cardiac arrest, he was rushed back to the ED where an intensive resuscitation ensued, with the wife and daughter standing outside watching. The unspoken dilemma was on the faces of the staff as they looked at the family – do we send them to the quiet room or do we allow them to stay and watch? The family was appropriately tearful and anxious, but not inappropriate or obstructive, and they were allowed to stay. Over the blurring next few minutes, many doctors and staff members were placing central lines, hanging vasopressors, performing CPR and visibly sweating while they valiantly provided this patient with critical care in an effort to restart his heart. During the chaos of the resuscitation, more family members had quietly gathered outside the room, watching and holding each other’s hands, united in hope. Occasionally they walked into the room and touched the man’s hand and spoke to him, with the staff working around them as they continued their effort. No bother, no question if they should be there or not. They just were, and it was alright. The daughter was watching the cardiac monitor, and realizing that the situation was grave, took her mother into the room to stand next to her husband. The daughter told her that it was time to say goodbye, because his heart wasn’t beating on its own anymore. The staff stepped away to allow all of the family members into the room, to be with him as his heart stopped and he breathed his final breath. During this code that ended 66 minutes later, the family was allowed to witness and experience the resuscitation and death of their beloved husband, father, grandfather and friend, and to say goodbye for the last time. Several days later, the wife and daughter were asked by the nurse manager how they felt about being there...
