Chapter 3: Family Presence

INTRODUCTION

The topic of family presence has been discussed for over 30 years, and yet it remains controversial.^1-6 The proponents of the family being present during the resuscitation argue that it is the patient’s and family members’ basic human right to be present during the resuscitation. They maintain that barring or excluding families from witnessing critical events is paternalistic. Many people have already witnessed critical events in public, on television shows, on the news, on cable, and on reality shows. As a result, families are somewhat prepared and have expectations. Opponents of the family being present during resuscitation are concerned with litigation, the emotional fallout from the witnessed trauma, and disruptions during the resuscitation. The authors of this chapter strongly support the family being present during a resuscitation.

This chapter is designed to provide a reference for the Emergency Physician (EP) regarding the family being present during the resuscitation of patients in the Emergency Department (ED). It reviews the current literature on this topic and offers some suggestions.

BACKGROUND

The notion of the family being present during resuscitation dates back to the 1980s. Foote Hospital in Michigan started a program in response to families that wanted to be present during resuscitation.⁷ Data from this program were presented in 1992 as formative research and have continued to be substantiated by more current publications.⁸ The current literature shows the perspective of both the patient and the family.^9-22 Most of those surveyed, including the parents of children, feel it was their right to be present during the resuscitation or invasive procedure of a family member. Furthermore, when family members are present during the resuscitation, they are more likely to believe that everything that could have been done was done for their family member.²³ In addition, 67% of parents who were present during the resuscitation of deceased children felt that being present during the resuscitation helped them cope with the death of their child.²³

Most patients with a critical illness would like to have their families present during resuscitation.^14,21 Concern that family members will suffer from posttraumatic stress disorder (PTSD) after witnessing their loved one resuscitated has not been substantiated.^24,25 A recent study of 65 family members of patients undergoing cardiopulmonary resuscitation (CPR) showed no difference in PTSD or depression in comparison to those who did not witness the resuscitation.¹⁶ In a multicenter randomized study, PTSD-related symptoms were significantly lower in family members who witnessed the resuscitation than the control group.¹⁷ Anxiety was also significantly lower in the intervention group that witnessed the resuscitation compared with those who did not witness the resuscitation. At 20 months of follow-up, there were no medicolegal claims of damages from the study participants.¹⁷

Professional organizations have positively endorsed the family being present during resuscitation.^26,27 The main ...