Ethical considerations after a patient dies
Ethics center issues overview of end-of-life care
As the spectrum of end-of-life issues continues to expand, more and more questions arise for clinicians working with patients, families, and institutions. The Center for Bioethics at the University of Minnesota has created an overview guide, End of Life Care: An Ethical Overview, to serve as a starting point for discussion of some of the ethical challenges attached to dying and death.
Included in the guide are issues that can arise after a patient’s death:
Organ donation: When a person dies, the medical provider may consult the person’s health care directive or their driver’s license for their organ donation wishes. In the absence of these documents, the health care professional may ask a family member for permission to use the organs for organ donation. Solid organs and tissues may then be removed from the body and given to an ailing person. Family members may also be asked if the body of the newly deceased person may be donated to science as well.
Autopsy: Autopsies may be used to determine the cause of death, for research and education, or for forensic evidence if death was a result of a crime or questionable circumstance. Autopsies may be performed on an entire body or on a single organ or tissue. The practice of autopsy has declined in recent years, but many professionals find autopsy an integral part of medicine. These professionals believe autopsies contribute much to the understanding of illness, the human body, disease, and death. Ethical issues concerning autopsy focus on respect for the dead body, retaining tissues from the body for study, and the applicability autopsy information has when examining the quality of care provided by a medical institution.
Practicing medical procedures on dead bodies: Medical students may practice procedures on newly dead bodies, usually without permission from the family. Two interests are in conflict when it comes to newly deceased patients: respecting the dignity of the deceased vs. the educational value of practicing procedures for medical students. The prevailing recommendation from the American Medical Association is that because practice with deceased bodies is valuable to students, training should be performed with dignity; with permission from the family, if possible; and in a structured and closely supervised environment.
Grief: After a person dies, the family, loved ones, and friends will experience grief and bereavement. For some people, viewing the body helps grieving and acceptance. Medical professionals can facilitate this by arranging a private and pleasant environment. Some believe that the medical profession has a duty to acknowledge the surviving family members after a patient’s death and that this obligation has a potential to be rewarding. Professionals may choose to send condolence cards, attend a funeral or refer families to grief groups.
Posthumous parenthood: During the mid-1990s, requests to retrieve sperm—in the hopes of using it to conceive children of the deceased male—started to increase. The issue of gathering sperm from a deceased individual raises ethical questions about choice in parenthood. Those who deal with this issue want to know: How should health care staff handle such a request? Who should be able to request sperm retrieval? What should be done if other family members raise objections? How can the wishes of the deceased be respected?
End of Life Care: An Ethical Overview is an original publication by the University of Minnesota’s Center for Bioethics, and is available in full on-line by going to www.bioethics.umn.edu and clicking on "Resource Center." Bioethics overviews addressing other topics are available on the site, as well.
As the spectrum of end-of-life issues continues to expand, more and more questions arise for clinicians working with patients, families, and institutions.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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