Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering

For patients who are suffering, the bedside presence of a family member can provide comfort, and many people hold that there is moral value in being present with a conscious, suffering patient. Yet what is the moral significance of the absence of family members when a patient is minimally conscious or unconscious and not aware of their absence? Clinicians are often troubled when family members and surrogate decision-makers who are able to spend a significant amount of time at an unconscious, seriously ill patient's bedside do not do so. Clinicians feel frustrated that they must bear the burden of witnessing the patient's actual or perceived suffering while the family escapes this burden and therefore appears to fail to uphold a duty to the patient. What are we to make of this point of view? What is the source of this frustration? What is the nature of the perceived duty? Is it morally defensible to request or require family members to be present with an unresponsive patient to bear witness to their actual or perceived suffering? If so, on what grounds?