The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life: Revised and Expanded Second Edition by Nancy BerlingerThe Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life: Revised and Expanded Second Edition by Nancy Berlinger

The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of…

byNancy Berlinger, Bruce Jennings, Susan M. Wolf

Paperback | April 30, 2013

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Decisions about life-sustaining treatment are often ethically challenging for patients, surrogate decision-makers, and health care professionals. Providing safe, effective, and compassionate care near the end of life is a priority for health care organizations. In times of uncertainty, crisis,or reflection, and in efforts to improve health care for seriously ill patients, guidelines can help.This is the first updated, expanded edition of The Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying, which shaped the ethical and legal framework for decision-making on treatment and end-of-life care in the United States. The new edition, theproduct of an authoritative consensus process, incorporates 25 years of research, innovation, and developments in law and policy. It summarizes the current framework for making good decisions about treatment and care and identifies educational and organizational goals for health care systems. Itcovers care planning, decision-making for adults and for children, care transitions, the determination of death, and the policies and processes that support good care at the bedside. It also addresses the psychological and social dimensions of care near the end of life, with attention to effectivecommunication with patients and loved ones and among team members. This book is written for physicians, nurses, and other clinicians in hospitals, nursing homes, home care, and hospice. It is structured for ease of reference during difficult clinical situations and includes extensive practical recommendations supported by print and online resources. This book isalso essential reading for clinical ethicists, ethics committee members, health lawyers, and medical and nursing directors. As the U.S. confronts the challenges of health care reform, an aging population, increasing technological capacity to extend life, and serious cost implications, The HastingsCenter Guidelines are invaluable to educators, scholars, and policymakers.

About The Author

Nancy Berlinger is a Research Scholar at The Hastings Center and teaches ethics in master's and doctoral programs at the Yale University School of Nursing. She directed the Hastings Center project that produced the revised edition of the Guidelines and is also the author of After Harm: Medical Error and the Ethics of Forgiveness (Johns...
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Title:The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of…Format:PaperbackDimensions:256 pages, 10 × 7 × 0.68 inPublished:April 30, 2013Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199974551

ISBN - 13:9780199974559

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Table of Contents

Preface to the Second EditionContributorsHow These Guidelines Are OrganizedIntroductionThe Function and Sources of These Ethics GuidelinesLegal and Ethical Consensus Informing These Guidelines: Rights, Protections, and Key Philosophical DistinctionsPart One: Framework and ContextSection 1: Ethics Goals for Good Care When Patients Face Decisions about Life-Sustaining Treatment or Approach the End of LifeSection 2: Ethics Education Competencies for Health Care Professionals Caring for Patients Facing Decisions about Life-Sustaining Treatment and Patients Approaching the End of LifeSection 3: Organizational Systems Supporting Good Care and Ethical PracticeSection 4: Social, Economic, and Legal ContextsA. Social ContextB. Economic ContextC. State and Federal ContextPart Two: Guidelines on Care Planning and Decision-MakingSection 1: Guidelines for Advance Care Planning and Advance Directives: Using Patient Preferences to Establish Goals of Care and Develop the Care PlanSection 2: Guidelines for the Decision-Making ProcessA. Evaluating the PatientB. Determining Decision-Making CapacityC. Identifying the Key Decision-MakerD. Surrogate Decision-MakingE. Making the Decision at HandF. Documenting the DecisionG. Implementing the DecisionH. Changing Treatment DecisionsI. Conflict and Challenges Related to Treatment Decision-MakingSection 3: Guidelines Concerning Neonates, Infants, Children, and AdolescentsA. General Guidelines for Pediatric Decision-Making Concerning the Use of Life-Sustaining TreatmentsB. Guidelines for Decision-Making and Care Involving Nonviable Neonates and Neonates at the Threshold of ViabilityC. Guidelines for Decision-Making about Life-Sustaining Treatment for Viable NeonatesD. Guidelines for Decision-Making about Life-Sustaining Treatment for Young ChildrenE. Guidelines for Decision-Making with Older ChildrenF. Guidelines for Decision-Making with AdolescentsG. Guidelines for Decision-Making by Mature Minors and Emancipated MinorsSection 4: Guidelines for Care TransitionsA. General Guidelines for Hand-Offs between Professionals and Transfers across Care SettingsB. Guidelines on Care Transitions for Nursing Home ResidentsC. Guidelines on Portable Medical OrdersD. Guidelines on Discharge Planning and Collaboration with Nursing Homes, Home Care, Hospice, and Outpatient CareE. Guidelines on Care Transitions for Patients Who Will Die in the HospitalSection 5: Guidelines for the Determination of DeathA. Procedural Guidelines for Making a Determination of Death and for Making a Declaration of DeathB. The Determination of Death: Continuing Ethical DebatesSection 6: Guidelines for Institutional PolicyA. Guidelines on Ethics Services in Institutions Providing Care for Patients Facing Decisions about Life-Sustaining Treatment or Approaching the End of LifeB. Guidelines on Palliative Care ServicesC. Guidelines Supporting Advance Care PlanningD. Guidelines Supporting Portable Medical OrdersE. Guidelines Supporting Care TransitionsF. Guidelines on the Role of Institutional Legal Counsel and Risk Management in Supporting Good CareG. Guidelines on Conflict ResolutionPart Three: Communication Supporting Decision-Making and CareSection 1: Communication with Patients, Surrogates, and Loved OnesA. Conducting a Family Conference When a Patient's Condition Is DeterioratingB. Supporting the Decision-Maker When Loved Ones DisagreeC. Discussing Values Concerning Nutrition and HydrationD. Using Electronic and Telephone Communications with Seriously Ill Patients or with Surrogates and Loved OnesSection 2: Communication and Collaboration with Patients with DisabilitiesA. Life-Sustaining Treatments and Accommodation of Stable or Progressive DisabilitiesB. Communication When a Patient's Disability Affects SpeechC. Communication When a Patient's Disability Affects CognitionD. Existential Suffering as a Factor in Treatment Decision-MakingE. Spirituality and Religion as Factors in Treatment Decision-MakingF. Religious Objections during Treatment Decision-MakingG. Moral Distress as a Factor in Treatment Decision-MakingH. Integrating Bereavement Care for Loved Ones and Professionals into Care Near the End of LifeSection 4: Decision-Making Concerning Specific Treatments and TechnologiesA. Forgoing Life-Sustaining Treatments: Ethical and Practical Considerations for CliniciansB. Brain Injuries and Neurological StatesC. Mechanical VentilationD. Cardiopulmonary Resuscitation and Cardiac TreatmentsE. DialysisF. Nutrition and HydrationG. Chemotherapy and Other Cancer TreatmentsH. Routine Medications, Antibiotics, and Invasive ProceduresI. Blood Transfusion and Blood ProductsJ. Palliative SedationSection 5: Institutional Discussion Guide on Resource Allocation and the Cost of CareA. Developing a Practice of Discussing Resource Allocation and the Cost of Care: Six StrategiesB. Discussing Uncompensated Care for Patients without InsuranceGlossaryCited Legal AuthoritiesSelected BibliographyIndex