Life-sustaining support: ethical, cultural, and spiritual conflicts. Part II: Staff support--a neonatal case study

As medical knowledge and technology continue to increase, so will the ability to provide life-sustaining support to patients who otherwise would not survive. Along with these advances comes the responsibility of not only meeting the clinical needs of our patients, but also of understanding how the family's culture and spirituality will affect their perception of the situation and their decision-making process. As the U.S. continues to become a more culturally diverse society, health care professionals will need to make changes in their practice to meet the psychosocial needs of their patients and respect their treatment decisions. Part I of this series (April 2002) discussed how the cultural and spiritual belief systems of Baby S's family affected their decision-making processes and also their ability to cope with the impending death of their infant. The development of a culturally competent health care team can help bridge the gap between culturally diverse individuals. This article addresses the following questions: 1. What legal alternatives are available to the staff to protect the patient from suffering associated with the continuation of futile life-sustaining support? 2. What conflicts might the staff experience as a result of the continuation of futile life-sustaining support? 3. What efforts can be made to support members of the staff? 4. What can be done to prepare others in the health care professions to deal more effectively with ethical/cultural issues?