Patient and family attitudes regarding the practice of procedures on the newly deceased

Performance of emergency lifesaving procedures is an integral part of emergency medicine resident training. Objective: To assess attitudes of ED patients regarding the practice of procedures on the newly deceased. Methods: A descriptive survey was administered to a convenience sample of ED patients and their families at two urban military Level-1 trauma centers. Subjects were asked about their overall opinions regarding the practice of nontherapeutic procedural skills on themselves or relatives immediately after death in the ED. Subgroup analysis included the issue of advanced permission and opinions regarding procedures defined by the investigators as noninvasive (e.g., laryngeal mask airway) or invasive (e.g., cricothyrotomy). Data were analyzed descriptively and with chi-square as appropriate. For comparison of proportions, a sample size of at least 140 was chosen for an alpha of 0.05 and a beta of 0.10 to detect an effect size of 0.3. Alpha was corrected for multiple comparisons prior to the study. Results: Three hundred seventeen surveys were collected and 88% (n = 280) were complete. Seventy-five percent (n = 290) and 70% (n = 273) of the respondents agreed to after-death procedures on themselves or their relatives, respectively. However, only 40% (n = 106) and 50% (n = 131) would allow such procedures without prior permission. Seventy-one percent (n = 189) were willing to give permission in a living will, while 85% (n = 238) indicated support of a wallet card format. There was no significant difference in permission rates when contrasting individual noninvasive and invasive procedures. Conclusion: Most patients are willing to have procedures performed on themselves or relatives shortly after death, yet the majority request that permission be obtained in advance. A living will or carried card would be acceptable for such permission.