The Last Family Member

A catastrophic consequence of cancer, an accidental car accident, an unexpected heart attack, a devastating stroke - there are so many chance circumstances that can end a person's life. Death and dying have no schedule, follow no agenda. Despite our best intentions as physicians, patients will pass away before all the family members and friends have arrived and come to terms with a situation. When death is imminent, we often get a request to "keep the patient alive until that last family member arrives." When is this appropriate? How long do we continue life-supporting measures for that last family member?

It's a tough question, fraught with emotion and ethical difficulties. On the one hand, caring for a patient at the end of life also means caring for their closest family members as their loved one passes on. On the other hand, aggressive intensive care support is a resource-heavy endeavor that can easily cost tens of thousands of dollars a day, and when these resources are used to support a patient who is dying, they are taken away from another patient who may need them to live. If a patient expresses clearly that he would not want to be kept alive in a vegetative state, but a brother is on his way to say goodbye, is it ethical to keep him going for another hour for his brother to arrive? If a patient has passed away (dead or brain dead), then how is keeping the vital signs "normal" meaningful to that last family member? Do physicians need to respect the family and community of a patient and the enormous act of a son flying across the country to see his father one last time?

I struggle a little with this aspect of end-of-life care. I think I err on the side of accommodating the last person as long as their travel is underway and the time estimate reasonable. But I am very aware of the limited resources this uses and the ethical quagmire it trespasses.