Meeting Physicians’ Responsibilities in Providing End-of-Life Care: Meeting the Needs of Families During Hospital-Based End-of-Life Care
Family members are important as surrogate decision makers, but they also require care during the dying process as much as—and sometimes more than—the patients themselves. For many patients, support of their family is an extremely important physician skill concerning end-of-life care. Therefore, physicians have a responsibility to provide medical care that supports the family. Hospitals and especially ICUs often are not “family-friendly,” being designed to meet other priorities than family needs and comfort. Families are often excluded from the bedside and ICU by visitation restrictions and by the preferences of clinicians during provision of care, including rounds and procedures. Physicians must work to ensure that end-of-life care in the hospital and the ICU does not exclude family members and that care is comparable to what they would want for their own family member.
Cultural Competency and the Role of Race, Ethnicity, and Religion
Physicians who practice in a multicultural environment have a responsibility to understand that family members from some cultures may have very different perspectives on the family’s role and on who should be involved in treatment decisions. Individuals from some cultures may not endorse tenets of Western clinical ethics, such as the equivalence of withholding and withdrawing life support or the definition of brain death. It is important to anticipate differences in perspectives and apply principles of culturally effective end-of-life care to these situations.