Family witnessed resuscitation; whose autonomy is it anyway?

Mcmahon-Parkes, Kate

Abstract

In most cultures, it is largely uncontentious that when a person is expected to die, that their end is made as comfortable and peaceful as possible, and that loved ones* should be permitted to be present at their death. In such cases, family presence offers comfort both to the dying person, and to those who are close to them.
However, when death is not anticipated, a resuscitation attempt is often initiated. The interventions required can appear brutal and undignified, and although resuscitation is undertaken with the aim of saving life, it is a reality that in the majority of instances when full cardiopulmonary resuscitation is instigated, the patient will die during the attempt.
For many years, international and professional guidelines have recommended that loved ones be allowed to remain with patients during resuscitation. However, although in paediatric cases, family witnessed resuscitation (FWR) is commonplace, when the patient is an adult, friends and family members are still frequently prevented from being present.
Various justifications have been presented within medical and nursing literature as to why FWR is not promoted. These include the views of healthcare professionals that the experience would be too traumatic for relatives, that loved ones may hamper the attempt, or that patient dignity or confidentiality could be compromised.
Although these justifications appear beneficent in origin, I will suggest that restricting FWR is morally problematic. Firstly, concerns about relative’s welfare and patient confidentiality are unjustifiably paternalistic, particularly when empirical data demonstrate that these ‘justifications’ for preventing FWR are largely based on conjecture rather than evidence. Secondly, it is inconsistent that FWR be widely facilitated for paediatrics but not adults. Thirdly, there are no convincing reasons why relatives should be prevented from being with a patient at the end of their life, simply because of the nature of the patient’s death. And finally, in cases where loved ones may be aware of the patient’s end of life preferences, and particularly where the patient has nominated a healthcare advocate, their exclusion during resuscitation inhibits legitimate decision making processes, and increases the likelihood that continuation or cessation of treatment may be against patient’s wishes, and therefore non-beneficent.
Consequently, in the absence of compelling individual reasons to the contrary, FWR should be practiced in all cases where loved ones or advocates wish to be present.

Citation

Mcmahon-Parkes, K. (2012, June). Family witnessed resuscitation; whose autonomy is it anyway?. Poster presented at 11th World Congress of Bioethics, Rotterdam, Netherlands

• Presentation Conference Type: Poster
• Conference Name: 11th World Congress of Bioethics
• Conference Location: Rotterdam, Netherlands
• Start Date: Jun 26, 2012
• End Date: Jun 29, 2012
• Publication Date: Jun 1, 2012
• Peer Reviewed: Not Peer Reviewed
• Keywords: family witnessed resuscitation, capacity, consent, children
• Public URL: https://uwe-repository.worktribe.com/output/946868
• Publisher URL: http://bioethics-international.org/index.php?show=links
• Additional Information: Title of Conference or Conference Proceedings : 11th World Congress of Bioethics