The ethics of exclusion and the myth of control.

Abstract

For just one moment, try to forget you are the emergency nurse. Step outside that world. Pretend you are someone else, and ask yourself: Is it really justifiable to routinely exclude someone who wants to be there from the bedside of a dying loved one, even if-perhaps especially if-the dying is sudden and unexpected? This question has provoked mild debate among emergency nurses recently,‘, 2 but in most institutions, family exclusion is still accepted as the norm, even ihough family presence has been shown to not interfere with resuscitation efforts.3, 4 Is such exclusion ethical? There are many ways to experience the events surrounding a resuscitation or “code” situation in the emerqency department. For you as nurse, the scenario follows a predictable course. The stretcher is swept into the room and you are among those immediately surrounding it. CPR is in progress. There are shouted questions, commands; the mood may be intense, but tlie circumstances are familiar. You take control; jrou’ve done this before; you play hero in the battle agsmst sudden, unexpected death. It feels good to be in control, to know what you are supposed to do and to do it skillfully, efficiently. In the background, almost ir)visibly, the family is hurried off to someplace else, someplace where they will be asked to stay, perhaps asked to provide information, while the heroic struggle is being waged. In a small room dotted with ominous boxes of tissue, they wait. But stop-you are not a nurse just now. Just now, you are a wife, wrenched from your safe and familiar world by your husband’s sudden collapse, his awful color, the strange distant sound of your own voice crying out in fear and love. Your hands are so shaky