Resuscitation witnessed by relatives
BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7074.144a (Published 11 January 1997) Cite this as: BMJ 1997;314:144
Has proved acceptable to doctors in paediatric cases
- A Goldstein, Consultant paediatriciana,
- K Berry, Consultant paediatrician (paediatric accident and emergency)a,
- A Callaghan, Clinical assistant (paediatric accident and emergency)a
- a Birmingham Children's Hospital NHS Trust, Birmingham B16 8ET
- bRoyal Hampshire County Hospital, Winchester SO22 5DG
- cDepartment of Clinical Geratology, Radcliffe Infirmary, Oxford OX2 6HE
Editor–We are interested in the debate about whether relatives should be allowed to witness resuscitation attempts 1 2 and support the Resuscitation Council's recent guidelines.3 For the past nine months our paediatric accident and emergency department has used a written protocol that designates senior and experienced nurses to be solely responsible for the relatives' needs when a child is undergoing resuscitation. Under this protocol, parents are invited to be present in the resuscitation room if they wish to be after they have been given a full explanation and after prior notification of the leader of the resuscitation team. Thus the first moments of the resuscitation are undertaken in the absence of the relatives, who are being informed by the designated nurse of the situation and the events they are likely to witness.
A recent poll of 27 doctors who are involved in paediatric resuscitation (nine consultants, five senior registrars, 13 registrars) showed that 23 had experience of a resuscitation witnessed by parents. Only three doctors thought that the experience for them had been negative (in two cases the parents had not been accompanied by an identified nurse, and in one the resuscitation had been prolonged unnecessarily because of the parents' presence).
The main themes arising included comments that doctors more experienced at resuscitation are more confident in allowing parents in the resuscitation room; parents should never be made to feel uncomfortable if they wish to leave (several parents had wished to remain with their child for only a few moments); and, essentially, an experienced, identified nurse should remain with the parents at all times, supporting them and explaining the events on behalf of the resuscitation team.
We would encourage emergency departments to develop the philosophy of inviting parents into resuscitation rooms if they wish to witness the resuscitation of their child as this does not hinder the resuscitation process. Emergency departments must have an identified, experienced member of staff whose sole responsibility is to the parents. Training in resuscitation and a coordinated resuscitation team are essential.
References
Might lead to a complaint for breach of confidentiality
- a Birmingham Children's Hospital NHS Trust, Birmingham B16 8ET
- bRoyal Hampshire County Hospital, Winchester SO22 5DG
- cDepartment of Clinical Geratology, Radcliffe Infirmary, Oxford OX2 6HE
Editor–The Resuscitation Council has proposed that, under certain circumstances, relatives of adult patients should be permitted to witness resuscitation attempts1. We disagree with this proposal for two reasons.
Firstly, it is not possible simply to extend what is acceptable in paediatric practice to the care of adults. Whereas parents have legal responsibilities for the medical care of their children, in Britain relatives have no legal rights for the care of adult patients.2 Doctors' primary duty is to patients, not relatives.
Secondly, the proposals ignore the requirements for patient confidentiality. Doctors are obliged not to disclose details of medical procedures to third parties without the patient's permission; those who breach this duty of confidentiality could find themselves the subject of disciplinary action.3 Of course, patients will often ask doctors to share clinical details with a relative or friend, but for adults there is no automatic right to this, and doctors should obtain patients' permission before discussing their clinical condition with others.2 Patients who are unconscious or gravely ill have the same rights to confidentiality as conscious patients, but it is, of course, impossible to obtain their views. In these circumstances doctors cannot assume that the patients would consent to their relatives witnessing their treatment. Indeed, between a quarter and a third of patients do not seem to want their relatives involved in decisions about whether resuscitation should be attempted,4 so it seems unlikely that these patients would want their relatives to witness the actual procedure. Just because most patients die after resuscitation attempts (and are therefore not able to complain) we cannot assume that they would consent to their relatives witnessing their potentially degrading treatment.
Doctors should obviously try to deal with relatives of those being resuscitated in a sensitive and caring way, but we would caution them against inviting the relatives of adult patients to witness resuscitation. If patients survive they may have a strong case for complaint against their doctor for breach of confidentiality.