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ADVANCE Perspective: Nurses

Guidelines on Care at End of Life Updated

Published May 21, 2013 8:44 AM by Linda Jones

A new set of consensus guidelines produced by The Hastings Center can help healthcare professionals improve care near the end of life. The guidelines clarify what is ethically and legally permissible in the U.S. regarding the use life-sustaining technologies, provide in-depth guidance on talking with patients and surrogates, and offer recommendations about how to improve the delivery of care.

The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life expands the Center's ethics guidelines first published in 1987.

"As the population ages, more people are living with chronic diseases. Advances in medicine have created both benefits and burdens, including problems of quality, safety, access, and cost.  We need to help patients and families better navigate their choices, and physicians and health care leaders must build systems of care that are wiser and more compassionate. Guidelines helps meet these challenges," said Mildred Z. Solomon, president of The Hastings Center.

The book gives guidance on a range of topics, including advance care planning and advance directives, determining decision-making capacity, and all aspects of surrogate decision-making for adults and children. It outlines strategies to help patients, families and professionals work together to resolve conflicts. It explains the cultural, psychological, and social factors, including religion and spirituality, that may shape people's values or influence how they make medical decisions, insights that can help health care professionals provide the most appropriate and respectful care.

The new edition of the Guidelines acknowledges cost as an ethical concern in healthcare. "The ethical goal of treating all patients equitably requires healthcare institutions to grapple with the moral as well as the fiscal dimensions of resource allocation and healthcare cost," the authors write. "Professionals need opportunities to discuss these difficult issues in an open and factually well-informed way." The book includes a guide for hospitals and other institutions, with six strategies to encourage productive discussions that can support the development and use of a transparent policy.

posted by Linda Jones

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