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

Abstract

The Hastings Center Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying (1987) was the first set of consensus-based ethics guidelines to help physicians and other health care professionals provide good care when patients and families face decisions about life-sustaining treatment and end-of-life care. This groundbreaking book, whose principal author was Susan M. Wolf, was widely consulted and influential in the U.S. and internationally. It was cited by Justice O’Connor in the U.S. Supreme Court’s Cruzan decision and helped shape the current ethical and legal framework for medical decision-making and end-of-life care. The revised and expanded second edition of this classic work in bioethics and health law, written by Nancy Berlinger, Bruce Jennings, and Susan M. Wolf, and published by Oxford University Press, reflects the past 26 years of empirical research and clinical innovation in palliative care, patient safety, and health care quality improvement, and features insights from more than 60 clinical experts, legal authorities, members of the disability community, and patient advocates.

The new edition’s broader scope covers advance care planning, chronic illness, disability, decision-making about starting, continuing, or forgoing treatment, and care near the end of life. A new section on pediatrics covers the care of infants, children, and adolescents, with attention to the implications of research findings on the neurodevelopment of decision-making capacity for decisions by older children and adolescents. The book’s greatly expanded material now includes sections on neurological states, decisions about nutrition and hydration, collaboration with patients who have disabilities, and resource allocation in an era of health care reform. In addition to clarifying consensus in key areas such as surrogate decision-making and palliative care, the new edition addresses debates on physician-assisted suicide, organ donation after cardiac/circulatory death, and the minimally conscious state.

Early praise for the new edition describes it as "a truly comprehensive textbook for ethical, legal, institutional, and psychosocial aspects of end-of-life care" (Robert Truog, MD, Harvard Medical School) and as "the sourcebook for how the ethics of life-sustaining treatment and care at the end of life should be taught, institutionalized and translated into clinical teaching and practice"(Kathleen M. Foley, MD, Memorial Sloan-Kettering Cancer Center).

Keywords: End-of-life care, medical decision-making, disability, physician-assisted suicide, death, bioethics, health law