There was a physician who once told a heartbroken family, “We did everything we could. It is my decision that there is nothing more we can do. He had injuries that were incompatible with life.” Donald Owens, Jr., PhD, recalls the comfort those words brought to that family.
In many cases, clinicians routinely ask the family for consent before removing a patient from life support. This may happen not because the clinician is seeking shared decision-making; rather, hospital policies require it. “That is a horrible thing to put a family through. What they hear is, ‘Are you willing to kill your loved one?’ And it’s not the family’s place to make that medical decision,” says Owens, chair of humanities and ethics in medicine emeritus and chaplain at the Tulane University School of Medicine.
Owens says it is the physician’s responsibility to inform the family if in fact they have done all they could for this patient, and there’s nothing more they can do. “Some physicians don’t like doing that because it’s uncomfortable,” Owens observes. “Futility is an issue that some physicians are not comfortable working with.”
Hospital administrators may be worried about litigation. Some demand the family give written consent for legal reasons. “I have no patience with lawyers or HR folks who insist that hospitals require the family to sign off,” Owens says. “What you are really asking them, from their perspective, is to sign a death warrant for their loved one.”
Conflict may ensue if families are put in this terrible position. There could be family members who feel guilty signing off on it, and then refuse to accept responsibility or the reality of the situation. “People assume that the physician knows more than we know. They expect us to work miracles, but when it comes to terminal moments, we can’t,” Owens explains.
Ethicists can help develop policies so the issue is clear in advance. For example, the policy can state that it is the physician’s place and responsibility to determine when measures are prolonging death instead of life for a patient. “The ones to make this decision are the physicians, not the family, who are not usually trained in medicine,” Owens offers.
Bad policies can cause deleterious effects on family in both the short and long term, Owens says. He has seen some family members suddenly become distraught when asked to sign off on the decision to withdraw life support. It also interferes with the grieving process, since families now have to deal with the thought that they approved of and gave permission for their loved one’s death. “This is an issue of ‘do no harm.’ Your patient is not just the person in the bed. It’s the whole family,” Owens says.