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

Berlinger, Nancy; Jennings, Bruce; Wolf, Susan M.

doi:10.1093/acprof:oso/9780199974566.001.0001

Cited by 119 publications

(96 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Developmental psychology research suggests that age 14, in general, represents the age at which decision making and problem solving abilities resemble those of adults. 5,[26][27][28] Thus age 14 was designated as the lower age limit in this analysis.…”

Section: Methodsmentioning

confidence: 99%

“…espite recommendations that end-of-life (EOL) discussions occur early in young adult patients with lifelimiting illnesses [1][2][3][4][5] and data indicating that advance care planning in adolescent and young adult (AYA) patients improves patent-surrogate congruence and understanding in EOL decisions, [6][7][8] significant barriers exist to the routine incorporation of goals of care discussions for this population. [9][10][11][12][13] Lack of such discussions can lead to undesired medical care, conflict between the medical team and families, and delay in the palliative care modalities aimed at reducing suffering.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Advance Directives on End-of-Life Care for Adolescents and Young Adults Undergoing Hematopoietic Stem Cell Transplant

Needle

Smith

2016

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: Little is known about the role of advance directives (AD) in end-of-life (EOL) care for adolescents and young adults (AYA) undergoing hematopoietic stem cell transplant (HSCT). Objective: The study objective was to describe the frequency, type, and influence of AD on the use of lifesustaining treatment (LST) in AYA patients undergoing HSCT. Methods: We performed a retrospective chart review of 96 patients aged 14-26 undergoing HSCT between April 2011 and January 2015 at the University of Minnesota. LST was defined as the use of positive pressure ventilation (PPV), dialysis, or CPR. Results: Of the 96 patients, survival was 72.9%, and 23% had an AD. Of the 26 patients who died, 13 (50%) had an AD. Among the 19 patients who died in the ICU, there was no significant difference in PPV, dialysis, withholding or withdrawing of LST, or timing of do not resuscitate (DNR) orders between those with ADs preferring LST (n = 5), those naming proxies only (n = 4), and those without ADs (n = 10). Patients with ADs expressing preference for LST were significantly more likely to receive CPR than those with proxies or those without ADs ( p = 0.02). Conclusion: A minority of AYA patients undergoing HSCT had ADs. Patients received care that was strongly associated with their preferences. With the exception of CPR, the use of LST did not differ between those with ADs and those without.

show abstract

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

The Impact of Advance Directives on End-of-Life Care for Adolescents and Young Adults Undergoing Hematopoietic Stem Cell Transplant

Needle

Smith

2016

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…For example, religious commitments are one example of culture, which, for some people, include specific values or prohibitions concerning medical interventions, such as Jehovah's Witnesses' refusal of blood products. In all such cases, it is crucial for clinicians to understand the patient's values as they may inform her treatment and care; these values may or may not correspond to her religious commitments or to those of her family members [3]. A clinician may or may not personally agree with these commitments or be able to accommodate them in a health care setting, but he or she should recognize that they are important to the patient.…”

Section: "Culture" As Distress Codementioning

confidence: 99%

“…Enlisting the help of a chaplain, social worker, or other team member with strong communication skills (including an interpreter if needed) can be helpful. Clinical ethics consultation can also be helpful if uncertainty about how to talk with a patient about her preferences concerning health-related information, and how to explain to family members why it is important to clarify the patient's preferences, persists among bedside clinicians [3]. In such cases, an ethically sound outcome may include a patient expressing a preference for diagnostic or prognostic information to be disclosed to a family member or the patient expressing a preference to receive some or all information directly.…”

Section: Clarifying "Family Values"mentioning

confidence: 99%

Culture and Moral Distress: What's the Connection and Why Does It Matter?

Berlinger¹,

Berlinger²

2017

AMA Journal of Ethics

View full text Add to dashboard Cite

Culture is learned behavior shared among members of a group and from generation to generation within that group. In health care work, references to "culture" may also function as code for ethical uncertainty or moral distress concerning patients, families, or populations. This paper analyzes how culture can be a factor in patient-care situations that produce moral distress. It discusses three common, problematic situations in which assumptions about culture may mask more complex problems concerning family dynamics, structural barriers to health care access, or implicit bias. We offer sets of practical recommendations to encourage learning, critical thinking, and professional reflection among students, clinicians, and clinical educators.

show abstract

“…The pediatric setting¹ is no different, where parents are the presumed decision-makers for their children.² According to this standard, parents are obligated to make decisions based on factors such as the child's apparent experience of illness, potential for suffering (physical or psychological), and ability to understand and tolerate treatment [1]. Yet, in the clinical setting, parents may be influenced by a variety of factors other than best interest when making treatment decisions for their children [2].…”

Section: Introductionmentioning

confidence: 99%

In Whose Best Interests? Critiquing the “Family-as-Unit” Myth in Pediatric Ethics

Raho¹

2016

Bioethics - Medical, Ethical and Legal Perspectives

View full text Add to dashboard Cite

In pediatrics, parents are the presumed surrogate decision-makers for their children. Parents are generally obligated to make decisions in the child's best interest. When assessing what is in the child's best interests, parents should consider the child's experience of illness, potential for suffering (physical or psychological), and ability to understand and tolerate treatment. Yet, parents may consider a variety of factors other than best interest when making treatment decisions for their children. Moreover, parents may equate the child's best interest with their own (or their family's) and make decisions that, in some situations, will place children at significant risk of serious harm. Clinicians may be reluctant to challenge parents due to a perception that their obligations require treating the family "as a unit." After detailing a case from the author's own practice in clinical ethics, this essay will challenge the view that "family-centered" (as opposed to "patient-centered") care is an appropriate ethical model for pediatric decision-making. Specifically, the physician-patient relationship-or, in this context, the pediatrician-child relationshipought not to be reconceptualized into the pediatrician-parent-child relationship, since the latter perspective potentially misidentifies who the patient is and may inadvertently suggest there is warrant for "treating" the family's suffering at the expense of the child's welfare.

show abstract

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

Cited by 119 publications

References 0 publications

The Impact of Advance Directives on End-of-Life Care for Adolescents and Young Adults Undergoing Hematopoietic Stem Cell Transplant

The Impact of Advance Directives on End-of-Life Care for Adolescents and Young Adults Undergoing Hematopoietic Stem Cell Transplant

Culture and Moral Distress: What's the Connection and Why Does It Matter?

In Whose Best Interests? Critiquing the “Family-as-Unit” Myth in Pediatric Ethics

Contact Info

Product

Resources

About