JHU PH 2002-20 (ethical obligations to patients' families)

[Dennis O'Shea]

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
Office of Communications and Public Affairs
615 N. Wolfe Street, W1600
Baltimore, MD 21205-2179
Media Contact: Tim Parsons
410-955-6878
paffairs@jhsph.edu
May 9, 2002

FOR IMMEDIATE RELEASE

RESEARCHERS INVESTIGATE NEEDS OF FAMILY MEMBERS WHEN A PATIENT DIES

The primary obligation of medical personnel is to the patient, yet when a 
patient dies, the needs of the patient's family take precedence, according 
to researchers at the Johns Hopkins Bloomberg School of Public Health. In a 
case report appearing in the May 2002 issue of the Journal of Clinical 
Ethics, the researchers explore several approaches for addressing the needs 
of families as they apply them to one particular family who experiences a 
sudden death.

"When you are dealing with a situation in which a patient dies, the 
patient's needs drop instantly;  he or she no longer requires medical care. 
At the same time, the family's needs remain and even intensify," explains 
lead author David Bishai, MD, MPH, PhD, an assistant professor of 
population and family health sciences at the Johns Hopkins Bloomberg School 
of Public Health. "One who considers patients in isolation from their 
families may reason that anything doctors do after a patient dies is not 
cost-effective. But it's imperative to realize actions taken after a death 
have a tremendous long-term impact on families. To ignore the interests of 
a bereaved family can lead to tragic results."

Dr. Bishai and co-author Andrew Siegel, JD, PhD, an assistant scientist of 
health policy and management at the Johns Hopkins Bloomberg School of 
Public Health, choose a case in which a woman was pronounced dead at her 
home and was never taken to the hospital to illustrate the unnecessary 
distress caused when medical personnel neglect the needs of the patient's 
family. The 38-year old woman experienced abdominal pain one evening and 
died from a ruptured appendix by the time her two daughters returned home 
from school the following day. When paramedics arrived, they took over the 
daughters' and neighbors' attempts to resuscitate the woman, but eventually 
pronounced her dead, without taking her to the hospital.The daughters 
stayed with their deceased mother for two hours while their father drove 
home. The mother's body was then taken directly to the medical examiner.

  In addition to dealing with their mother's death, the experience left the 
daughters, ages 11 and 13, with a fear of returning to the home where she 
died, concern that their efforts to perform CPR were inadequate, and anger 
that more efforts were not taken to help her.

The case study points out that while transporting the woman to the hospital 
would have been of little if any benefit to her, it would not have caused 
her any additional harm, and it would have been beneficial for the family. 
Paramedics are not trained in bereavement counseling. If taken to the 
hospital, the family would have been in the care of emergency department 
staff, who are trained to provide support to suddenly bereaved families. 
They would also have the peace of mind that all possible efforts were made 
to save the woman's life.

The authors discuss three general approaches for incorporating a family's 
interests into medical decision making: viewing family members as patients 
suffering from acute bereavement; equally weighing the needs of the patient 
and the family; and weighing a family's interest while giving primacy to 
the patient's wishes. Each approach has strengths and limitations, yet all 
share an important feature in that they recognize the existence of 
obligations to the family that are not derived from obligations to the patient.

"Whether you argue the case for one or another of these approaches, the 
important thing to realize is that each addresses the rights of family 
members. Perhaps nothing should come before maximizing efforts to save the 
life of a patient or to respect a patient's wishes. Yet when a patient 
dies, the work of medical personnel is not over. Their responsibilities 
continue in addressing the needs of family members," concludes Dr. Bishai.

                                                              ###

"Moral Obligations to Families When There is a Sudden Death" was written by 
David Bishai and Andrew Siegel and appears in the May 2002 issue of the 
Journal of Clinical Ethics.

Johns Hopkins Bloomberg School of Public Health news releases can be found 
on the World Wide Web at http://www.jhsph.edu.

Information on automatic e-mail delivery of science and medical news 
releases from Johns Hopkins University is available at 
http://www.jhu.edu/news_info/news/listserv.html.