PSYCHOLOGIC CONSIDERATIONS IN THE MANAGEMENT OF DEATHS ON PEDIATRIC HOSPITAL SERVICES

The aid given by the physician to the family of a child who dies in the hospital begins before that event and continues after it. The competence, sincerity and consideration shown by the medical staff during the period of fatal illness establish the atmosphere in which this crucial human experience occurs. The most important aspect of this atmosphere is the relationship between the physician and the patient, including his family. This relationship has the potential of helping the family to cope with their grief when the child dies. This is optimally achieved when there is one doctor whom the parents can identify as the child's physician. It is necessary to emphasize the importance of the one doctor when the most efficient hospital service is continuously faced with the weakening of this relationship, because of the many professional personnel actively involved in hospital care of patients. The child's physician provides the medical continuity in the management of the patient in his fatal illness. Althoug there is the tendency and opportunity to withdraw one's interest from the fatally ill child in the hospital, the physician's persistent attention and efforts are of real value to the dying child and his family. This is not to say that unrealistic, last-minute procedures are necessary or can make up for a lack of attention earlier in the course of the dying patient. By making the child and parents as comfortable as possible the physician establishes himself as one who will help them endure the crisis for which they are preparing. Through his skill in communicating with child and parents in this situation the physician helps the child and family to feel appropriately dependent on the doctor and his staff. Unless a parent is severely disturbed emotionally, the best preparation he can have for the painful and tragic experience of losing his child is to know what is going to happen next, insofar as it is possible to know. The parents may need to have the diagnosis, as well as the nature of the treatment, explained many times before they will be able to understand and accept the painful reality of the situation.