A relative has a cardiac arrest. An emergency medical technician performs CPR and rushes your relative to the nearest emergency room. You provide some information at the front desk and then the ER nurse invites you to enter the cardiac arrest room so you can witness the resuscitation of your relative. The nurse assures you that you won’t be in the way, and your presence won’t negatively impact your relative’s care. You panic – do you join the doctors or not?
In the past, most family members at an ER were immediately sent to a waiting area where they sat, imagining what was happening to their loved one. Was everyone doing everything they could? Was the relative in pain? Did the medical team give up too soon? Eventually, a doctor would come into the waiting area and share the news with you. But today, many medical centers are doing away with visiting hours and other barriers to family contact and encouraging families to be with their hospitalized loved ones.
Studies show that families who witness the resuscitation of a loved one are less likely to experience post-traumatic stress disorders than are those families sent to the waiting room. The same studies show that having the family present during the resuscitation did not increase the stress of the medical team, nor did it interfere with medical care. And there was no increase in malpractice litigation.
Still, according to a recent poll in the New England Journal of Medicine, many doctors remain strongly opposed to having family present during a cardiac arrest, fearing that the psychological impact on family from watching a family member die may be long term and not easily measured. These doctors also worry about foul language sometimes used among providers during the resuscitation and discussions that take place around uncertainties of care. But rough talk can and should be eliminated whether families are present or not. And discussions around uncertainty is not a bad thing – if we were more willing to admit to our medical uncertainties, I suspect people’s expectations of health care would be far more realistic.
But remember, it is only recently that our family members died in hospitals far away from their loved ones and the environments they knew. Hospitals can provide amazing interventions and sophisticated monitoring of sick people, but they are not always the best place to receive care – using the old-fashioned definition of “care.” We have sterilized death and made it clinical and quantitative. We have removed the family at the very time when they need to say their last good-byes. They need to know that everything that should have been done was done in a respectful and compassionate manner.
How do you feel? Should family be allowed to witness a cardiac arrest? Do you feel that being with a family member as he or she dies would help you with with grieving?
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at email@example.com.