The death pronouncement is one of the most sensitive and complex part of communication in and out of hospital, intensive care. It comprises more than the actual declaration of death. It may be a relatively straight forward when the death is expected and the family is mentally prepared and accepting the outcome. However, when the doctor is interacting with a grief-stricken family, dealing with the death of a child, or coming to terms with the death of a personal patient, a death pronouncement becomes complex. Problem is compounded often in presence of violent relatives, non acceptance of death, medico legal cases and especially in cases of unnatural causes for the death. Relatives often refuse to accept death and within no time mobs swell in number, threatening of physical and verbal assaults and revenge against the doctor in various forms. Although there can be specific protocols and hospital policies, it will still depend upon the timely thoughts and skills of the doctor, how to handle the situation. Doctors should be better trained for handling of death as it can put them in risky situation, because of following reasons.
- Death itself is a complex issue. Even today modern science has not reached scientifically at the bottom of life and death.
- Communication of death is complex. It varies with each patient, type of relatives, place, country and every situation in same hospital is different.
- Declaration of death is a legal matter. How a doctor verifies death, communicates and documents death, it can create legal and other problems for doctor.
Any problem related to declaration of death is immediately picked by media and the initial reaction is to blame the doctors. The doctors in such cases are projected as incompetent and callous, and that makes a media news. Invariably one stray incidence is used as to project whole medical community in negative manner. Later inquiries and further inquiring continue, and even later truth emerges, that is not enough to bring back the lost prestige for medical profession.
Take for example the latest news of “ Alive Baby declared dead.”
Later after two days, news was “ hospital enquiry claims No negligence in alive baby declared dead”
Above news just conveys the complexity of situation, doctors often face. My aim here is to convey that communication of death is a very complex subject. Ironically no structured training of emotional, communicative and legal issues is imparted to medical students. But they are supposed to face the situation everyday, when they function as doctors.
Most legal determinations of death are certified by medical professionals who pronounce death when specific criteria are met. Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death).
Especially new doctors need to realize that the structure of modern society is to make life and death, medical and then legal matters, and to subject the most basic elements of our existence to professional authority. The birth certificate and the death certificate are signed by doctors, and then registered by the civil authorities. Because of all these sensitive issues, emotional aspects and legal dimensions of death being huge, so need more attention. .
In remote areas doctors are totally alone and helpless, so security issues will remain. There is no solution in sight for these problems. Already I have written about a “real story of female doctor assault”.
Problem is that doctors during training days or residency are not trained in such kind of communication. Although while doing their duties they observe seniors and learn how they are communicating. But still when actual situations arise, which can be diverse, complex and challenging, and everyday getting more demanding. In view of current scenario against doctors, they need better training on these issues. Basic question is, if doctor needs help, where can he turn to for help or information. The resources, other staff and the setup is not of much help in difficult scenarios. It is not uncommon that doctors are left to themselves, if a difficult situation arises. Medical education and Hospital systems need to be better equipped to provide more support to doctors in present era. For doctors, if they make a mistake, there is no one to support them or save them from verbal, physical assaults, law and medico legal cases.
Harassment is tremendous. Therefore doctors, be careful – save the patient, but save yourself also.