Ethical and legal considerations in video recording neonatal resuscitations

Abstract

As guidelines for neonatal resuscitation evolve from a growing evidence base, clinicians must ensure that practice is closely aligned with the available evidence, based on methodologically sound and ethically conducted research. This paper reviews ethical, legal and riskmanagement issues arising during the design of a qualityassurance project to make video recordings of neonatal resuscitations after high-risk deliveries. The issues, which affect patients, researchers, staff and the hospital at large, include the following: 1) Informed consent for research involving emergency procedures is often not possible, for lack of time to provide sufficient information. The mental capacity of the subject or parent may be compromised by the impending emergency, and freedom of choice is threatened by the time pressure to consent. 2) Video recording of the inevitable medical errors raises issues of whether participating staff may be identifiable and accountable, affecting their willingness to participate in such research. The approach to staff participation and identification is reviewed.3) The use of video data for education threatens the privacy of research subjects. The ethics of maintaining privacy is balanced with the ethics of using the data to improve practice of resuscitation. 4) The research subjects (patients, or the staff whose performance is being monitored) must be defined. 5) There are legal and ethical aspects of management and ownership of data. 6) The role of the Human Research Ethics Committee in protecting the research subject and possibly the medicolegal interests of the hospital is discussed. This paper reviews the literature and discusses the issues.In 2007, the Department of Paediatrics, Mercy Hospital for Women, embarked on a project of video recording of neonatal resuscitation. In planning this project a number of ethical, legal and riskmanagement issues arose, affecting patients, researchers, staff and the hospital at large. These issues concerned the validity of the consent process, the privacy of staff and research subjects, the management of video data and the role of the Human Research and Ethics Committee (HREC). We review the literature surrounding these issues, explore how they relate to our project, and discuss our approach to them. OUR PROJECTThis project entailed the video recording of resuscitation after high-risk deliveries, primarily for the purpose of quality assurance. These were predominantly the births of premature infants or other deliveries in which the likelihood of the need for resuscitation could be predicted in sufficient time to allow consent processes and the organisation of the necessary team. A number of deliveries were recorded at short notice, when unexpected emergencies occurred at a time when the team and equipment were available.A digital video camera was fixed to the radiant warmer, the field of view including the bed, therefore capturing only the hands of the operators and the baby. Sound recordings were also made and voices could be recognised.Video data were assesse...

Debriefing in the Emergency Department After Clinical Events: A Practical Guide

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