Moral Worlds and Institutional Scripts at the End of Life.

This commentary responds to Jennifer Blumenthal-Barby and colleagues' article, "Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering." The authors examine clinicians' moral distress when family members are absent from the bedside of dying patients and assess moral arguments for requiring family presence. We concur with their skepticism toward any strong obligation for family members to be physically present when continued treatment is considered burdensome or futile. We extend the authors' analysis by arguing that institutional culture shapes expectations of the "good patient," the "good family," and the "good death." Drawing on sociology, anthropology, and philosophy, we suggest that clinicians' distress may arise not only from family absence but also from tensions between institutional norms and the moral worlds families inhabit. We conclude by calling for epistemic humility and greater critical reflection on the impact of institutional norms on moral judgments.