After a motor vehicle crash, a 65-year-old man and his 43-year-old daughter were brought to our trauma center. Despite life-threatening injuries, the father was conscious and repeatedly asked to be with his daughter, who died while being prepared for surgery.
Facility policy requires the attending physician (or a designee) to notify the next of kin when a patient dies, so I didn't say anything to him about his daughter's death. He was informed by family members the next day. Now he's claiming that I withheld information, violating his right to informed consent and to be present with his daughter before she died. Did I act unethically?-C.V., S.C.
Patients have the right to receive full information about their own condition when they're being asked to give informed consent or to refuse treatment. The information your patient wanted about his daughter was probably unrelated to the process of informed consent unless at some point he was asked to consent to treatment on her behalf.
Many EDs and trauma centers have policies similar to yours. For example, some policies specify that information about a patient's death not be given to a severely ill patient until the patient's condition has improved and a family member can be with him. Most hospitals bring in a specially trained professional, such as a chaplain, to be with a patient when he's given bad news.
Even so, most ethicists recommend taking special care not to lie to a patient. Instead, make reasonable promises; for example, "We know you're concerned about what's happening with your daughter and we'll get information to you as soon as possible. Your wife's been called and is on her way to the hospital."
The issue of family presence during resuscitation attempts is controversial. For a thoughtful examination of the issue, see "Issues in Nursing: Should Families Be Present during Resuscitation?" in the May issue of Nursing2007.*
*Individual subscribers can access this article free online at http://www.nursing2007.com. [Context Link]