Living and Dying: Family Decisions
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Decision making about living and dying is a critical concern of families and has assumed a new moral significance. This first issue of a new interdisciplinary journal sponsored by the Michigan Council on Family Relations presents six invited articles that address situations facing families and children. Related book reviews on dying, grief, and loss are also included.
Key Words: family, death, decisions, parents, children
We are pleased to introduce the inaugural issue of the Michigan Family Review (MFR). This new publication, sponsored by the Michigan Council on Family Relations, will provide a means of communication about current critical issues facing families in Michigan and across the country. MFR is an interdisciplinary publication focused on scholarly inquiry and professional application in a variety of fields, with an emphasis on the needs of practitioners who provide services and education to families, of community and citizen action groups, and of family members themselves.
In this first issue titled "Living and Dying: Family Decisions," the invited articles and book reviews focus on a theme that connects two universal developmental processes in families. In one way or another, death—like birth—is often considered a family event. Tending to health, illness, and death is typically a function and responsibility of families. Of all human groups, families may be the most intimate, with strong and significant interpersonal bonds among members. These relationships are expected to last a lifetime; however, when death occurs—whether sudden or expected—social, emotional, and economic consequences result that have enduring impacts on families and individuals at all ages of the lifespan (Sigelman & Shaffer, 1995).
The certainty of death is a fact that every person must at some time accept. How a person goes through the process of dying and accepts death, however, is closely linked to the way the person's society and culture view the process. A person's family and friends, cultural values, and medical and social institutions all comprise part of the context in which individuals die. (Dudley, 1992, p.13.)
The social and cultural experiences of individuals within families, their emotional lives and personalities, their ages at the time of the death, and their economic roles and responsibilities in society will interact and contribute subtly to the ways in which family members cope with death. For example, research with adults who lost a parent during childhood indicates that their perceptions of care and protection after the loss predict their current attachments and openness to social support many years later (Blume & Glickfield, 1994).
In contemporary society, decision making about living and dying has become a critical concern of families and has assumed a new moral significance. Recent scientific knowledge about disease prevention, improvements in health care delivery, and—especially—increasingly sophisticated medical technology make it possible to maintain life beyond what was possible just a few decades ago. As a result, family members as well as health care professionals are faced with increasingly complex medical-ethical decisions surrounding living and dying (Fraser & Stum, 1994; Nelson, 1992).
During the past few years, the state of Michigan has been in the national spotlight of issues surrounding decision making and dying. The controversial cases of Dr. Jack Kevorkian, whose activities raised legal and ethical questions regarding physician-assisted suicide, and of Dr. Gregory Messenger, who was recently found innocent in the death in his premature infant son after disconnecting mechanical life support, clearly have placed Michigan residents in the public eye (Stein, 1995).
In April 1995 the Michigan, Indiana, and Ohio Councils on Family Relations are meeting jointly to discuss "Living and Dying: 21st Century Decisions." Because of advances in health, medicine, and related technical know-how, individuals and families have become increasingly dependent on professionals for help in deciding how to handle the chronic illness and death "management" of loved ones, as well as the legal and economic aspects of living and dying. Also at issue are questions surrounding the "best interest" of persons who are unable to make their own decisions and individual/family control versus external autonomy in controversial areas such as providing life support, palliative care services, and assisted suicide.
In this issue of the Michigan Family Review, the first three articles raise basic—albeit controversial—topics that need to be considered by medical, health, and family professionals; by ethicists, religious leaders, and public policy makers; and by families themselves as they contemplate living and dying. James Lindemann Nelson, Associate for Ethical Studies at the Hastings Center in New York, examines the moral authority of our most intimate connections—our family—and argues that families should have a say in how end-of-life decisions and choices are made.
Howard Brody, Director of the Center for Ethics and Humanities in the Life Sciences at Michigan State University, confronts the specific issue of the family's role in physician-assisted suicide. Brody raises questions regarding the principle of individual autonomy and suggests that such freedom is exercised within the context of social relationships.
Leonard J. Weber, Director of the Ethics Institute at the University of Detroit Mercy, reflects on proposed legislation in the Michigan Senate that would permit the implementation of "Do Not Resuscitate" orders for patients in non-hospital settings. Weber asserts that this debate is part of a larger issue about the overall role of the family in American society.
The final three articles address specific situations facing families and children. The invited authors offer concrete, helpful information for health care professionals and parents. Margaret L. Campbell, Clinical Nurse Specialist on the Comprehensive Supportive Care Team of Detroit Receiving Hospital, suggests several strategies that health care providers can use to facilitate the difficult task of breaking bad news to the families of dying patients.
Patricia J. Bauer, Neonatal Intensive Care Specialist at Munson Medical Center in Traverse City, Michigan, presents a case study and a thoughtful overview of the need for family-centered care during one of the most difficult crises faced by families—caring for an infant in the neonatal intensive care unit. Bauer strongly recommends system changes in hospitals to address the needs of newborns and their families.
Mark W. Speece, Research Psychologist and Assistant Professor in the Department of Internal Medicine at Wayne State University, reviews the literature on children's concepts of death and suggests that mature understanding is more complex than previously assumed. Speece delineates four components of the death concept that have been the focus of research and proposes an additional one.
Also in this issue, we have included related book reviews prepared by seven family-related or health-care professionals and scholars from Michigan. Some of the books reviewed focus on issues related to dying, while still others focus on grief and loss. MFR is intended for a wide audience. We anticipate that professionals in health, social services, law, education, mental health, family therapy, ethics, religion, and many other related fields—as well as students, policy makers, and members of families will find information and ideas of value.
As co-editors of the Michigan Family Review, we sincerely thank the Board of Directors of the Michigan Council on Family Relations and Executive Director Jeanne Brown for their support, and we congratulate the members of the MFR Editorial Review Board for their insight and willingness to address this critical topic in the first issue of the journal. We invite feedback from our readers and encourage you to submit articles and book reviews related to future themes of the journal.
Blume, L. B., & Glickfield, B. (1994, April). Adult attachment and social support as a function of perceived parental care and mourning behavior after early parent loss. Paper presented at the Biennial Meeting on Human Development, Pittsburgh, PA.
Dudley, W. (1992). Death and Dying: Opposing Viewpoints. San Diego: Greenhaven.
Frazer, M., & Stum, M. (1994, November). Long term care decision making: Perceptions of distributive and procedural justice. Paper presented at the Theory Construction and Research Methods workshop of the National Council on Family Relations, Minneapolis, MN.
Nelson, J. L. (1992, July-August). Taking families seriously. Hastings Center Report, pp. 6-12.
Sigelman, C. K., & Shaffer, D. R. (1995). The final challenge: Death and dying. In Life-span Human Development (2nd ed.). pp. 479-507.
Stein, S. (1994, January 29). Born too soon. Detroit Free Press Magazine, pp. 8-10, 13.