Human Biology, University of Virginia, Charlottesville, Virginia, USA.
Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore, Singapore;
J Med Ethics. 2017 Oct;43(10):676-678. doi: 10.1136/medethics-2016-103881. Epub 2017 Feb 23.
Many families of patients hold the view that it is their right to be present during a loved one's resuscitation, while the majority of patients also express the comfort and support they would feel by having them there. Currently, family presence is more commonly accepted in paediatric cardiopulmonary resuscitation (CPR) than adult CPR. Even though many guidelines are in favour of this practice and recognise potential benefits, healthcare professionals are hesitant to support adult family presence to the extent that paediatric family presence is supported. However, in this paper, we suggest that the ethical case to justify family presence during paediatric resuscitation (P-FPDR) is weaker than the justification of family presence during adult resuscitation (A-FPDR). We go on to support this claim using three main arguments that people use in clinical ethics to justify FPDR. These include scarcity of evidence documenting disruption, psychological benefits to family members following the incident and respect for patient autonomy. We demonstrate that these arguments actually apply more strongly to A-FPDR compared with P-FPDR, thereby questioning the common attitude of healthcare professionals of allowing the latter while mostly opposing A-FPDR. Importantly, we do not wish to suggest that P-FPDR should not be allowed. Rather, we suggest that since P-FPDR is commonly (and should be) allowed, so should A-FPDR. This is because the aforementioned arguments that are used to justify FPDR in general actually make a stronger case for A-FPDR.
许多患者家属认为,在亲人进行心肺复苏时在场是他们的权利,而大多数患者也表示,有家属在旁会感到安慰和支持。目前,在儿科心肺复苏(CPR)中,家属在场比成人 CPR 更为常见。尽管许多指南都支持这种做法,并认识到其潜在益处,但医疗保健专业人员在支持成人家属在场方面犹豫不决,而儿科家属在场则得到了更多支持。然而,在本文中,我们认为,为儿科复苏期间家属在场(P-FPDR)辩护的伦理理由比成人复苏期间家属在场(A-FPDR)的理由更弱。我们接着使用人们在临床伦理中用于为 FPDR 辩护的三个主要论点来支持这一说法。这些论点包括缺乏证据证明会造成干扰、事件发生后对家属的心理益处以及对患者自主权的尊重。我们表明,与 P-FPDR 相比,这些论点实际上更适用于 A-FPDR,从而质疑医疗保健专业人员普遍允许后者而主要反对 A-FPDR 的态度。重要的是,我们并不是要暗示不应允许 P-FPDR。相反,我们认为,既然普遍(并且应该)允许 P-FPDR,那么也应该允许 A-FPDR。这是因为,用于普遍为 FPDR 辩护的上述论点实际上为 A-FPDR 提供了更有力的理由。