Death Pronouncement

  • Death is usually an easy diagnosis. If death is uncertain, lack of pulse, breath sounds, and heartbeat will usually suffice.
  • Occasionally, the clinician may be fooled by a prolonged respiratory pause, as occurs in Cheyne-Stokes respirations. If in doubt, observation of respirations for several minutes is advised.
  • Such common practices as shining a bright light into the pupils, or “assessing for pain” with a sternal rub are unnecessary and to be avoided if possible.
  • Death pronouncement is a solemn ritual, the importance of which transcends the business of certification. If family is present, pronouncement may formally give permission for loved ones to grieve. As a rule, families should not be asked to leave during pronouncement, although some may wish to do so. In the process of pronouncement, condolences can be offered and the bereaved consoled.
  • Even if no one else is present, pronouncement provides an opportunity for clinicians to say goodbye, to reflect on care delivered, and to bear witness to the passing of another human being (Hallenbeck 2003).

 

Death Pronouncement

If called to pronounce someone unknown to you:

  • Inquire as to the circumstances of the death (anticipated or not)
  • Inquire as to whether family is present and, if present, their condition (quietly grieving, dazed, angry, etc.)
In entering the room of the deceased:

  • First, calm yourself

If family are present:

  • Assess their initial reaction (actively grieving – anxious waiting for your evaluation).
  • Do NOT ask them to leave – you should be able to do a brief examination with family present – pulse, respirations, and heartbeat.
  • Clearly communicate that the person has died and offer condolences.
  • Pause for their acute grief reaction; remain quiet, yet available; do not speak too much.

Respond simply to immediate reactions and questions:

  • Console as you feel is appropriate to your relationship.
  • Give permission for them to take some time prior to next steps such as autopsy requests or notification of others.

In departing, model saying goodbye to the deceased, as seems appropriate to the circumstances.

Mr. Stanton’s Case part 2

View the following simulated case on video, paying attention to the interactions and effectiveness of communication among the physician, the patient and the patient’s family.

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How would you have done this differently?

Let’s try this again with more effective techniques.
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