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January 30, 2008

P.A. 95-181: Religious Beliefs About Time of Death - Supplemental Information

On August 22, we sent you a memo regarding Public Act 95-181, which amends the Hospital Licensing Act, effective January 1, 2008, to require that "Every hospital must adopt policies and procedures to allow health care professionals, in documenting a patient’s time of death at the hospital, to take into account the patient’s religious beliefs concerning the patient’s time of death."

The legislative sponsor has recently requested that the Association provide supplemental information to hospitals that reflects the legislative intent of this new law by suggesting ways that hospitals and health care professionals, in developing the mandated policy, can take into account the patient’s religious beliefs concerning time of death, and hopefully avoid further distress to the patient’s family in situations in which religious beliefs impact end-of-life decision making. This supplemental memo should serve to further raise hospitals’ awareness of the issues of concern and encourage hospitals to consider positive ways to effectively and sensitively address them.

Some patients hold religious beliefs that do not agree with the neurological or brain function criteria and believe that death occurs only upon irreversible cessation of circulatory and respiratory functions. Where a patient’s religious objection to the brain death standard is identified, and the patient has little or no brain function remaining, the hospital should consider instituting the following as part of its policies and procedures:

• Assemble the appropriate hospital professionals and resources such as the social worker, chaplain, ethics committee, risk management and legal counsel, as early as possible to address the situation.
• Provide that the appropriate hospital resources and the patient’s care team communicate with the patient’s family or legal representative and explore how to accommodate the family’s requests related to the patient’s religious beliefs. One of the possible requests such patients or their families may make is to request that the clinical testing that confirms cessation of brain function not be performed in cases where there is a religious objection to brain death as a method for ascertaining death.
• Implement hospital policies that discuss how health care professionals may take into account religious beliefs, including specific accommodations such as continuation of life support until irreversible cessation of the patient’s cardiac and respiratory function.
• Accommodate the religious belief to the extent possible.

Hospitals and health care professionals have a significant role to play in assisting families who are experiencing the demise of a family member. Sensitivity to the religious beliefs of the patient or the patient’s representative regarding time of death is crucial and can be enhanced by early identification of such patients and ongoing communication with them and their families. Hospitals are encouraged to consider:

• Reviewing hospital procedures for communicating with patients regarding religion and religious beliefs, during the admission process or early in their hospitalization.
• Asking patients if they have any religious beliefs that the hospital should be aware of that may influence patient care. If the patient lacks decision-making capacity, consult the patient’s legal representative or next of kin.

We hope this additional information will assist hospitals as they draft provisions to comply with P.A. 95-181. If you have any questions, please contact Howard Peters at hpeters@ihastaff.org or 630.276.5480 or Barb Haller at bhaller@ihastaff.org or 630.276.5474.