Clinical Ethics Case Study 10: For the record: Should our patient’s relatives be able to record her treatment?

A referral to the CEC from the manager of the Accident and Emergency Department F, a 67-year-old woman, was brought in to the Accident and Emergency (A&E) Department by ambulance on a busy Friday night with acute chest pain. Her family (husband and adult daughter) arrived soon afterwards. F was not in good general health: she had diabetes and severe asthma, although these were well managed and F was compliant with ongoing treatment. She was also obese and involved in a weight loss programme through her local health centre. 2 Soon after her arrival in the A&E Department, F went into cardiac arrest and stopped breathing. A resuscitation trolley arrived in good time and a team began to work to try and resuscitate F. At this point, F's adult daughter H entered the treatment area. She retrieved her mobile phone from her bag and began to film the resuscitation attempt. This behaviour alarmed the multidisciplinary team treating F and H was asked to cease recording. The reasons for their request for H to stop were: that the team were becoming distracted and concerned that this intervention could disrupt the care they were providing to F; the effect H's filming may have on other patients and visitors; and how such footage might be interpreted in the future. Nevertheless, H was determined to continue filming. She claimed that: ‘It's our right to film our mother. If she dies, this will help the rest of our family to say goodbye. Plus, if we're worried she hasn't received the best possible treatment, this will help us later on’. H was, however, asked again to stop filming and reluctantly did so. F's resuscitation was successful and she was moved from A&E to the cardiac care ward, where she remains unconscious but slowly improving. Three days later, I (the manager of the A&E Department) received a written complaint from H and F's husband T, saying that they should have been allowed to continue filming the A&E staff resuscitating F. Through some background investigation, H had established that there was no Trust policy on relatives filming patients, or indeed any policy about patients themselves recording consultations and treatment. H claimed that: ‘several of my friends record their medical consultations to help them remember everything, and what we wanted to do is no different from that’. She also stated that ‘this is no different to family members taking photos of their loved ones to remember them by’. On behalf of the A&E Department, I am therefore approaching the CEC for assistance before responding to H's complaint. We are worried that while some people may seek to record or film consultations as an aide memoire in times of stress or for personal reassurance, others may do so for more litigious or unusual purposes (such as making the material available on the Internet). We are also concerned about how such material may be interpreted by an inexpert audience. Further, we worry about patient consent to this filming and the disruptive nature of the practice. On contacting the Trust's communications department, we have established that there seems to be a gap in hospital policy regarding this kind of recording activity, as the only relevant policy is one relating to requests from the press to film on site – with requests for filming or photographs needing to be approved by the Trust's director of communications. The communications department has received requests for clarification as to whether this policy would cover the use of phones or other hand-held devices for recording. From speaking to colleagues in other departments I have also heard anecdotal reports that such attempts at recording are on the increase – from both relatives and patients themselves. Some patients have also apparently attempted to take photographs of other patients with whom they have shared a ward, with claims that this has taken place with verbal consent. We are approaching the ethics committee with the following questions in mind: 1. Should H have been allowed to continue filming? 2. Is H's claim that filming resuscitation is akin to recording other more routine consultations defensible? 3 3. If a patient is unconscious, should a family member be able to record them, or should recording only be possible if a patient consents in advance? What should happen if a patient specifically requested such filming? Or, should recording not be permitted at all? (This is also interesting in relation to giving birth.) 4. Is Trust policy on this issue, to cover and protect both patients and staff, needed? If so, how might such a policy be structured? How could it be implemented in the hospital?This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

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