Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Presence in Final Moments


Traditionally, we have "protected" families from witnessing abrupt or unexpected death in our hospitals. This assumption may be incorrect; offering families the chance to be present can be what is wanted and needed.


There is no amount of planning to prepare family for the loss of a loved one. More so, questions about cardiac arrest—will it happen, what will life be like if one survives—are queries that continue to challenge physicians and researchers.


While these questions are grappled with on the intellectual front, there is a persistent assumption in medicine that there should be a visual barrier between the team of healthcare professionals reviving a patient’s heart and the patient’s family. This barrier, we assume, is in the family’s best interest.



Challenging assumptions

It turns out, this may not be the case. Research focused on the effects of family watching a team’s attempt to revive their loved one shows that it can have a positive effect on well-being, as well as increased understanding of what has been done to try to save their loved one. Dr. Daniela Lamas’ recent op-ed in the New York Times captures such a moment, in which a patient’s wife thanked the physician and the team for their efforts in reviving her husband.


Watching the team attempt to save a family member may sometimes be what the family needs to gain closure. Given the growing evidence, as well as Dr. Lamas’ op-ed, clinicians should include an option for the family to be present during their loved one’s cardiac arrest.



Shifting the culture of medicine

Witnessing the passing of a human often results in growth for physicians regardless of their years in medicine. This can sometimes also be true for for family members. We must work to shift the old culture of patriarchal beliefs and attitudes that create barriers between families and their family member’s last moments. Offering families the chance to be present can be what is wanted and needed.