Hospitals, visitors and morality


I am a member of a hospital ethics committee.  A few years ago we engaged in a yearlong discussion about whether to permit family members in the emergency room.  Some patients’ families had complained that when it was most important to be close to a loved one, they were shut out, literally kept behind closed doors, anxiously awaiting news that often took hours in coming. They wanted to see, to offer kind words and, if possible, hold a hand, provide a soothing touch. The physical separation was excruciating, compounding the anxiety of not knowing their loved one’s fate.

In deciding whether to recommend a change in policy, the committee considered questions such as: Would a layperson interfere with the work of medical personnel; would families misconstrue as assault the sometimes necessary but brutal procedures used on patients in extreme cases; would doctors and nurses need to divert attention to families who may react adversely to the bloody scene they were witnessing; would the hospital be opening itself up to malpractice suits because families would see what wasn’t done?

Most doctors initially opposed a policy change. But after a review of the experiences of hospitals where families could enter emergency rooms, we proposed a change. Hospitals that had an open door policy had fewer lawsuits and greater patient and family satisfaction, even if the patient died. People had a newfound appreciation of the tremendous care and effort that goes into the work in emergency rooms. And most medical personnel adapted to the change and found it had no impact on their ability to carry out their duties.

For many years now fathers and others routinely populate delivery rooms, but some hospitals are re-thinking the policy. I wondered, if emergency rooms can cope with non-medical personnel, what’s the problem with delivery rooms? The new concern in delivery rooms arises because of the ubiquitous digital camera capturing every moment of birth and those pictures posted on Facebook. Some parents are outraged at the ban on picture-taking. “It’s my child,” says Laurie Shifler, the mother of a newborn. “Who can tell me I can a picture or not take a picture of my own flesh and blood?” She says, “It’s about our rights.”

Patients do have rights. That right is the right to be treated respectfully and the right of patients to reject treatments, if they so choose. Doctors have the duty to treat the best they can; whether to accept this or any treatment is the patient’s (or surrogate’s) right.

Having a family member in a treatment room isn’t a patient’s right but a privilege granted by the hospital. As with the emergency room, there may good reasons to grant the privilege. But if it turns out that having others in the emergency room leads to worse care for patients, then the privilege can and should be revoked. If hospitals now experience picture taking interfering with proper deliveries, then cameras need to be prohibited.

Erin Tracy, of Mass General, is quoted in the New York Times saying, “When we had people videotaping, it got to be a bit of a circus. I want to be 100 percent focused on the medical care, and in this litigious atmosphere, where ads are on TV every 30 seconds about suing, it makes physicians gun-shy.”

An infant’s health shouldn’t be compromised for the sake of a parent’s wish to have their baby’s image captured the second of birth or that of the mother moments before. Babies are cuter after they’ve been washed and cleaned, anyway, and children like the circuses better when they’re older.

 

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One thought on “Hospitals, visitors and morality

  1. The age of the ubiquitous smart phone, digital camera, facebook and the like raises so many fascinating new moral questions. Individual narcissism versus collective good/social relationships that go beyond texting seems to be the battle that will be waged in most instances. I’m glad ethics boards exist in some situations to take away the ability to let narcissism win out.

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