Explaining death to children

Medical education--addressing the needs of the dying child

This paper reviews the formulation of attitudes, the acquisition of knowledge and the development of skills which together enable medical practitioners to provide comprehensive palliative care for terminally ill children. Ideally, these should be developed to such an extent that a 'good death' can be achieved. Current medical education does not address these areas and the associated issues, including the breaking of bad news, understanding the grief reaction to serious illness and children's perceptions of death. Neither does training include how to take management decisions concerning informed consent, the transition from active treatment to palliative care, symptom control and choosing the place for care. These, and the unintentional attitude that regards the dying child as a 'medical failure', are discussed, together with the need to meet the needs of the parents and siblings, and the effects of bereavement. Finally, recommendations are made for undergraduate curricula and the need to emphasize the relationship of caring for the family unit, and not just the patient.

Brain death: the family in crisis

Brain death has created a new class of dead people that does not conform to society's expectations of normal death and dying. Brain death also causes intense emotions and great stress for the family and friends of the person concerned. Nurses play a major role in helping the family through this distressing time by maintaining high standards of nursing care. Major components of this care include effective communication and caring that supports the family. While these families have a variety of special needs, it is the nurses' constant bedside presence that provides many opportunities to have a positive influence on family members' ability to cope with the tragedy and begin the healing process.