Family members can develop post-traumatic stress syndrome when they watch their loved ones go through life-threatening illnesses, according to two studies published in medical journals. The first study by Dr. David Wendler, director of the Unit on Vulnerable Populations at the National Institutes of Health Department of Bioethics, looked at families of terminally ill patients and found they experience extreme stress when they are asked to make end-of-life decisions. Many told researchers that they felt as if they were in lose-lose situations in that "pulling the plug" meant they were killing a person they love and allowing him to stay on machines meant he continued to suffer. "They feel like they are being asked to be the agent of the demise of someone they really care about," Dr. Wendler said. "Not surprisingly, that is really stressful and hard." The study found that about one-third experienced major distress, and some had severe symptoms of PTSS, such as nightmares, flashbacks, and agony over the situation even years later About half the families of dying people have to make end-of-life decisions for their loved ones. Dr. Wendler said it is easier if the person signed an advance directive that spells out in writing what his wishes and beliefs are. This study was published in the Annals of Internal Medicine. The second study, this time in the Journal of Clinical Oncology, found that only one out of 171 parents of children with cancer did not develop post-traumatic stress, a disorder related to post-traumatic stress syndrome, but not as severe. For example, a parent with post-traumatic stress might have had two instead of three symptoms required for a PTSS diagnosis, but his two symptoms could be very severe, such as nightmares and intrusive thoughts. Parents of children with cancer live with constant dread of recurrence. Routine check-ups and regularly scheduled MRIs and tests can make them feel helpless and afraid that they will result in another round of chemotherapy, nausea, hair loss, and radiation treatments for their children. Parents of children who died often go back over events and blame themselves for not being caring enough; for example, they admonish themselves for correcting a child with an undiagnosed brain tumor for being clumsy and subject to spills. Among the recommendations were for parents to interact with other parents whose children have cancer, and for oncologists to screen parents for PTSS.