Changing Times, Changing Opinions: History Informing the Family Presence Debate

Significant debate currently exists within emergency medicine over whether a patient’s family should be allowed to observe a critical resuscitation in the emergency department (ED) (‘‘family presence’’). Proponents of this practice would like family members to have the choice to be present during these desperate efforts that are often the final moments of patients’ lives. However, many medical professionals, physicians in particular, are strongly opposed to the idea, citing a wide range of legitimate concerns: that relatives will interfere with or misunderstand medical efforts, that the events will be too upsetting for relatives to bear, and that family presence will create additional stress and anxiety for the medical team. Opponents also often express the notion that family presence is a fundamentally unsound idea, contrary to all medical reason and wisdom. In the words of one trauma surgeon, ‘‘[Family presence] should not be a point of academic discussion . . It should simply be labeled ‘ludicrous.’’’ Opinions denouncing family presence, such as the one above, are frequently presented as steadfast and unarguable. Yet one does not need to look very far back in medical history to find another strongly felt, seemingly indisputable belief held by the medical establishment, a belief that was completely turned on its head within a short period of time. We are referring to the fact that less than 40 years ago, many physicians considered it highly inappropriate for fathers to attend childbirth. While childbirth and critical resuscitation are very different events with very different outcomes (most of the time), they also have some important and striking similarities. Notably, both the beginning of life (childbirth) and the end of life (a frequent result of critical resuscitation) have historically been community events, widely attended by friends and family. With the advent of modern medicine, both gradually evolved from public ceremony to private act, eventually losing their places as important community rituals. Even more important similarities are found in the passion, convictions, and justifications that have underlain the opposition to allowing family observers at both of these events.