Robert H. Coombs and Pauline S. Powers
In days gone by, death was a family experience. In the hamlets and villages of rural America, people usually died at home attended by family members and friends of long acquaintance. At the moment of death, these intimate associates were often present, providing comforting care, exchanging meaningful words, and then observing the termination of breathing and the total relaxation of the body. 1
In striking contrast, death in the contemporary urban setting now occurs primarily in hospitals and other medical facilities. Only rarely are family members or friends present during the final moments of life. Instead, the dying are attended by medical and paramedical specialists, each highly trained to perform technical services in combating disease and death. Presiding over this staff of technical experts is the attending physician. He is the commander-in- chief, the one authoritative figure recognized by others as inevitably concerned with dying and death. Not only does he orchestrate the clinical efforts of staff, but he is also required by his presiding role to decide when the patient is dead (an increasingly complex decision), to sign the death certificate, and then to confront the family with the news.
It is no easy matter to learn this difficult role successfully, for potentially conflicting demands are often placed upon the physician. 2 He is not only expected to be expert in applying highly specialized technical skills, but he also must treat the patient--and his family--with gentleness and sympathy. His main job is to cure if possible, but he must also relieve and comfort. All of medicine's scientific advances have not eliminated the patient's need for warm sensitivity and understanding concern.
But the doctor cannot take death and dying too personally: he is expected to retain composure, no matter how dramatic or tragic the death scene might be. Rationality and clearness of judgment in