title: Accommodating religious beliefs in the ICU: a narrative account of a disputed death.
abstract: Despite widespread acceptance in the United States of neurological criteria to determine death, clinicians encounter families who object, often on religious grounds, to the categorization of their loved ones as "brain dead." The concept of "reasonable accommodation" of objections to brain death, promulgated in both state statutes and the bioethics literature, suggests the possibility of compromise between the family's deeply held beliefs and the legal, professional and moral values otherwise directing clinicians to withdraw medical interventions. Relying on narrative to convey the experience of a family and clinical caregivers embroiled in this complex dilemma, the case analyzed here explores the practical challenges and moral ambiguities presented by the concept of reasonable accommodation. Clarifying the term's meaning and boundaries, and identifying guidelines for its clinical implementation, could help to reduce uncertainty for both health care professionals and families and, thereby, the incremental moral distress such uncertainty creates.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Smith
authors.forename: Anne Lederman
authors.initials: AL
authors.lastname: Flamm
mesh_terms: D016223:Advance Directives / Q000941:ethics*; D001926:Brain Death / Q000175:diagnosis*; D003657:Decision Making; D034462:Dissent and Disputes; D005195:Family Relations; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics*; D033262:Narration; D011368:Professional-Family Relations / Q000941:ethics*; D012067:Religion