Analyzing Attitudes and Delineating a Strategy for Family Presence in Cardiopulmonary Resuscitation

Abstract

The presence of a patient’s family during cardiopulmonary resuscitation (CPR) in the emergency department is one of the most complex challenges in medical ethics and emergency services management. It sits at the intersection of patient rights, the emotional needs of families, and the professional efficiency of the treatment team. The absence of a standardized strategy has led to numerous practical, psychological, and ethical conflicts. This document explores four policy options to address the question of family presence during resuscitation: complete prohibition of family presence, voluntary presence coordinated by the resuscitation team, presence conditional on the patient’s prior wishes, and the development of a local protocol. Each option presents distinct advantages, disadvantages, stakeholders, and implementation barriers. While complete prohibition may be more practical, it conflicts with cultural values and family expectations in Iran. The patient-centered approach, though ethically appealing, faces significant limitations in emergency situations. A combined strategy appears to be the most effective approach for health policymakers. In the short term, developing and disseminating an interim national guideline focused on voluntary and managed attendance could be beneficial. In the medium term, pilot projects should be implemented to test this guideline, ensuring essential conditions such as safe physical space and psychological support. At the same time, efforts should begin to design a comprehensive local protocol with input from all stakeholders. Ultimately, this pathway will lead to the establishment of a coherent long-term system that balances the effectiveness of the resuscitation team, the rights of patients and families, and sociocultural considerations. © 2026, Isfahan University of Medical Sciences(IUMS). All rights reserved.