The Presence of Family Members During Brainstem Testing: An Ethical Dilemma

The purpose of this article was to discuss the ethical issues relevant to inviting family members to witness brainstem testing in the intensive care unit (ICU). To highlight these issues, we begin by discussing a hypothetical clinical case of a patient admitted to the ICU following an out-of-hospital cardiac arrest. A brief review of the literature on current practice will be presented, followed by a balanced discussion on the practice of permitting relatives to witness brainstem testing under the ethical principles of beneficence, non-maleficence, autonomy and justice. Finally, we will present a discussion on international recommendations surrounding this practice as well as a proposed research agenda to further understand the risks and benefits of family members witnessing brainstem testing. We conclude that offering family members the opportunity to witness brainstem tests in the ICU may support them in understanding the term brain death and might contribute to their closure.