What is The Hastings Center?

Established in 1969, The Hastings Center is an independent, nonpartisan, and nonprofit research institute that addresses ethics issues in health, medicine, and the environment as they affect individuals, communities, and societies.

What is ethics?

Ethics is critical thinking about what we value, how we act on values, and how we distinguish between right and wrong action. Ethics encompasses our deepest questions about how people should act to relieve suffering and prevent harm, which is why ethics is central to the practice of medicine. Medical ethics uses tools such as principles, expert consensus, and other standards relevant to medicine, nursing, and other health care professions, to help professionals do the right thing in challenging situations.

Why do health care professionals need ethics guidelines?

Ethics guidelines provide a framework for discussing and making difficult decisions under stressful conditions.  When a patient faces an uncertain prognosis and needs to discuss the benefits and burdens of different treatment options in terms of the patient’s own values, or when it is unclear what a patient whose condition is deteriorating would have wanted, or when there is conflict, clinicians turn to ethics guidelines for help.  Ethics guidelines are based on well-established ethical and legal consensus about good care. They are useful to bedside clinicians, to professionals who teach clinicians, and to professionals who make policy in health care organizations. Ethics guidelines are broader than technical medical guidelines or legal advice, but support the use of evidence-based practice guidelines and accurate knowledge of law and policy.

What are The Hastings Center Guidelines?

In 1987, The Hastings Center published the first set of ethics guidelines to help health care professionals provide good care under difficult circumstances. The Hastings Center Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying was a groundbreaking book that became the most influential publication in the Center’s history. It was cited in the Supreme Court’s Cruzan decision (1990), which established the Constitutional right to refuse medical treatment. It helped to shape the ethical and legal framework for medical decision-making and end-of-life care we rely on today.

The Hastings Center has now revised and greatly expanded this essential resource. The new edition is coauthored by Nancy Berlinger, Bruce Jennings, and Susan M. Wolf. The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life: Revised and Expanded Second Edition was published by Oxford University Press in Spring 2013.

What’s new about the second edition of The Hastings Center Guidelines?

Broader scope. The new Guidelines support decision-making about starting, continuing, or forgoing life-sustaining treatment in any health care setting. It covers chronic illness and planning for future care in addition to end-of-life care. It features a major section on pediatrics, covering special issues in the care of infants, children, and adolescents. It highlights the special concerns of disabled patients when making treatment decisions and working with health care professionals.

Practical advice on communication and collaboration. The new Guidelines offer extensive recommendations and insights to help people communicate, work together, and deal with conflict. It explains how emotions, relationships, culture, religion, and spirituality may factor into a patient’s decisions, to prepare professionals to discuss these complex issues. It recommends strategies to help professionals develop the skills they need so they are well-prepared to work with patients, families, and each other.

Evidence and insights on quality, safety, access, and cost.  The new Guidelines reflect 26 years of research and innovation from the quality improvement, patient safety, and palliative care movements. It addresses teamwork, continuity of care during handoffs and transfers, and the integration of palliative care into treatment and care plans. It includes a discussion guide to help health care professionals talk constructively about resource allocation and the cost of care.

Web and print resources. The new Guidelines include web resources, plus a selected bibliography of more than 500 publications.

How can The Hastings Center Guidelines help busy doctors and nurses who don’t have time to read a whole book?

The Hastings Center Guidelines can be used in different ways to suit the needs of clinicians, educators, and other audiences.  It is structured for easy reference in difficult clinical situations. Each section of the book can also be used as a teaching tool. The ebook version offers a searchable electronic Index, helpful for quickly locating topics of interest. The Guidelines website is free, public, and offers additional resources.

What do The Hastings Center Guidelines have to say about controversial topics, such as physician-assisted suicide?

The book includes a valuable summary of the current legal and ethical consensus in the United States, with descriptions of key legal and policy developments, such as the right to refuse life-sustaining medical treatment, processes for surrogate decision-making, and also state-level law and policy permitting physician-assisted suicide (PAS).  This summary supports clinician education, including about topics that are often misunderstood – or, in the case of PAS, that continue to be debated within American medicine and American society – and helps clinicians to avoid common errors when discussing these topics.  The Guidelines also highlight other important debates in medical ethics, such as the debate over organ donation after cardiac death (DCD), again with attention to supporting clinician education and clear communication. The Guidelines offer extensive attention to decisions about nutrition and hydration, mindful that these decisions may be particularly stressful for families or may be compromised by faulty knowledge of legal or other requirements.  Decisions on behalf of brain-injured patients can be undermined by inaccurate terminology, and so the Guidelines offer key definitions of neurological states as a communication aid for clinicians and families.

How can The Hastings Center Guidelines help patients and families?

The Hastings Center Guidelines help health care professionals focus on what patients and families care about. It describes clearly the steps professionals can and should take to support good planning, decision-making, and care when people are seriously ill. It also offers a selection of web-based resources that professionals can share, or that patients and families can use on their own through the Guidelines website.

Where can people find The Hastings Center Guidelines?

The book can be purchased in print or ebook from Amazon or the publisher: The Hastings Center Guidelines: Revised and Expanded Second Edition