This major new work updates and significantly expands The Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying. Like its predecessor, this second edition will shape the ethical and legal framework for decision-making on treatment and end-of-life care in the United States. This groundbreaking work incorporates 25 years of research and innovation in clinical care, law, and policy. It is written for physicians, nurses, and other health care professionals and is structured for easy reference in difficult clinical situations. It supports the work of clinical ethicists, ethics committee members, health lawyers, clinical educators, scholars, and policymakers. It includes extensive practical recommendations. Health care reform places a new set of challenges on decision-making and care near the end of life. The Hastings Center Guidelines are an essential resource.

Nancy Berlinger is a Research Scholar at The Hastings Center and teaches ethics at the Yale University School of Nursing. She directed the Hastings Center project that produced the revised and expanded second edition of the Guidelines. Bruce Jennings is Director of Bioethics at the Center for Humans and Nature and teaches ethics at the Yale University School of Medicine. He is an elected Fellow of The Hastings Center and was a co-author of the first edition of the Guidelines in 1987. Susan M. Wolf is McKnight Presidential Professor of Law, Medicine & Public Policy at the University of Minnesota, and a Faculty Member in the University's Center for Bioethics. She is an elected Member of the National Academy of Science's Institute of Medicine, elected Fellow of the AAAS, and elected Fellow of The Hastings Center. She directed the Hastings Center project that produced the first edition of the Guidelines in 1987, and was principal author of that work.

Preface to the Second Edition Contributors How These Guidelines Are Organized Introduction The Function and Sources of These Ethics Guidelines Legal and Ethical Consensus Informing These Guidelines: Rights, Protections, and Key Philosophical Distinctions Part One: Framework and Context Section 1: Ethics Goals for Good Care When Patients Face Decisions about Life-Sustaining Treatment or Approach the End of Life Section 2: Ethics Education Competencies for Health Care Professionals Caring for Patients Facing Decisions about Life-Sustaining Treatment and Patients Approaching the End of Life Section 3: Organizational Systems Supporting Good Care and Ethical Practice Section 4: Social, Economic, and Legal Contexts A. Social Context B. Economic Context C. State and Federal Context Part Two: Guidelines on Care Planning and Decision-Making Section 1: Guidelines for Advance Care Planning and Advance Directives: Using Patient Preferences to Establish Goals of Care and Develop the Care Plan Section 2: Guidelines for the Decision-Making Process A. Evaluating the Patient B. Determining Decision-Making Capacity C. Identifying the Key Decision-Maker D. Surrogate Decision-Making E. Making the Decision at Hand F. Documenting the Decision G. Implementing the Decision H. Changing Treatment Decisions I. Conflict and Challenges Related to Treatment Decision-Making Section 3: Guidelines Concerning Neonates, Infants, Children, and Adolescents A. General Guidelines for Pediatric Decision-Making Concerning the Use of Life-Sustaining Treatments B. Guidelines for Decision-Making and Care Involving Nonviable Neonates and Neonates at the Threshold of Viability C. Guidelines for Decision-Making about Life-Sustaining Treatment for Viable Neonates D. Guidelines for Decision-Making about Life-Sustaining Treatment for Young Children E. Guidelines for Decision-Making with Older Children F. Guidelines for Decision-Making with Adolescents G. Guidelines for Decision-Making by Mature Minors and Emancipated Minors Section 4: Guidelines for Care Transitions A. General Guidelines for Hand-Offs between Professionals and Transfers across Care Settings B. Guidelines on Care Transitions for Nursing Home Residents C. Guidelines on Portable Medical Orders D. Guidelines on Discharge Planning and Collaboration with Nursing Homes, Home Care, Hospice, and Outpatient Care E. Guidelines on Care Transitions for Patients Who Will Die in the Hospital Section 5: Guidelines for the Determination of Death A. Procedural Guidelines for Making a Determination of Death and for Making a Declaration of Death B. The Determination of Death: Continuing Ethical Debates Section 6: Guidelines for Institutional Policy A. Guidelines on Ethics Services in Institutions Providing Care for Patients Facing Decisions about Life-Sustaining Treatment or Approaching the End of Life B. Guidelines on Palliative Care Services C. Guidelines Supporting Advance Care Planning D. Guidelines Supporting Portable Medical Orders E. Guidelines Supporting Care Transitions F. Guidelines on the Role of Institutional Legal Counsel and Risk Management in Supporting Good Care G. Guidelines on Conflict Resolution Part Three: Communication Supporting Decision-Making and Care Section 1: Communication with Patients, Surrogates, and Loved Ones A. Conducting a Family Conference When a Patient's Condition Is Deteriorating B. Supporting the Decision-Maker When Loved Ones Disagree C. Discussing Values Concerning Nutrition and Hydration D. Using Electronic and Telephone Communications with Seriously Ill Patients or with Surrogates and Loved Ones Section 2: Communication and Collaboration with Patients with Disabilities A. Life-Sustaining Treatments and Accommodation of Stable or Progressive Disabilities B. Communication When a Patient's Disability Affects Speech C. Communication When a Patient's Disability Affects Cognition D. Communication and Collaboration with Recently Disabled Patients Concerning Life-Sustaining Treatments Section 3: Psychological Dimensions of Decision-Making about Life-Sustaining Treatment and Care Near the End of Life A. Coping as a Factor in Treatment Decision-Making B. Hope as a Factor in Treatment Decision-Making C. Ambivalence, Denial, and Grief as Factors in Treatment Decision-Making D. Existential Suffering as a Factor in Treatment Decision-Making E. Spirituality and Religion as Factors in Treatment Decision-Making F. Religious Objections during Treatment Decision-Making G. Moral Distress as a Factor in Treatment Decision-Making H. Integrating Bereavement Care for Loved Ones and Professionals into Care Near the End of Life Section 4: Decision-Making Concerning Specific Treatments and Technologies A. Forgoing Life-Sustaining Treatments: Ethical and Practical Considerations for Clinicians B. Brain Injuries and Neurological States C. Mechanical Ventilation D. Cardiopulmonary Resuscitation and Cardiac Treatments E. Dialysis F. Nutrition and Hydration G. Chemotherapy and Other Cancer Treatments H. Routine Medications, Antibiotics, and Invasive Procedures I. Blood Transfusion and Blood Products J. Palliative Sedation Section 5: Institutional Discussion Guide on Resource Allocation and the Cost of Care A. Developing a Practice of Discussing Resource Allocation and the Cost of Care: Six Strategies B. Discussing Uncompensated Care for Patients without Insurance Glossary Cited Legal Authorities Selected Bibliography Index