Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

Abstract

Background and ObjectivesVaried meanings of death within medicine, bioethics, and society at large often produce disagreement and frustration between physicians and surrogate decision makers. We investigated whether teaching medical students about the philosophical aspects of death would change their attitude toward surrogate decision makers who assert nonstandard views of death.MethodsAn 80-minute lecture covering philosophical debates surrounding medico-legal standards of death was given to second-year medical students at Oakland University William Beaumont School of Medicine during a neuroscience course. Participants completed a questionnaire containing Likert scale and open-ended questions before and after the intervention assessing their acceptance of, frustration toward, and likelihood of accommodating a request for surrogate decision makers who posited either a whole-brain, high-brain, or circulatory view of death. Change in knowledge was analyzed using the McNemar test, whereas attitudinal scores were compared with pairedttests. Open-ended responses were narratively analyzed to identify themes that elaborate quantitative findings.ResultsA total of 43 paired responses were analyzed from second-year medical students. Following the intervention, students expressed less frustration (χ¯diff= −0.64, 95% CI −0.15 to −1.15), greater likelihood of accommodating ventilator removal (χ¯diff= 0.60, 95% CI 0.41–0.85), and greater acceptance (χ¯diff= 0.63, 95% CI 0.28–0.91) of surrogates who endorsed a whole-brain view of death. Although students rated the high-brain view as more acceptable after the lecture (χ¯diff= 0.63, 95% CI 0.28–0.91), they were not more likely to remove a ventilator from a patient who had experienced high-brain death (χ¯diff= 0.19, 95% CI −0.30 to 0.67). Students were less likely to continue artificial ventilation for a brain-dead patient (χ¯diff= −0.61, 95% CI −0.91 to −0.30) despite no change in frustration toward the surrogate (χ¯diff= −0.26, 95% CI 0.20 to −0.70).DiscussionChanges in attitudes across the 3 views of death suggest that increased awareness of the philosophical debate facilitates reflection of students' understanding and opinion of death. These findings support implementation of educational interventions to prepare students for future work with surrogate decision makers holding diverse sets of views on death.

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

“…There have been several new publications related to education on BD/DNC determination since the WBDP. 48 128 166 167 168 169 170 171 In 2021, Rubin et al published a description of the purpose, design, and early findings of the Neurocritical Care Society's Brain Death Determination Course. 166 Su et al described the success of a three-pronged BD/DNC quality-improvement initiative implemented in China in 2013 in a 2022 publication: (1) training of health care professionals via theoretical teaching, bedside teaching, simulation training then testing; (2) establishment of BD/DNC demonstration hospitals via personnel qualification, collection of appropriate equipment, and management of documentation; and (3) quality control at the hospital, province, and national levels with subsequent review of records from certified hospitals.…”

“…48 Additionally, there have been several efforts to optimize education for both trainees and health care professionals about both performing BD/DNC evaluation and techniques for effective communication and religious and cultural views on death using a variety of innovative techniques (e.g., simulation, e-learning tools, virtual reality). 128 167 168 169 170 171…”