Academic journal article The Hastings Center Report

"Take It and Read."

Academic journal article The Hastings Center Report

"Take It and Read."

Article excerpt

It's never a good day when someone has to turn to "ethical guidelines." This was one of the observations from the January 2007 plenary meeting of The Hastings Center's Guidelines on End of Life Care project. We talked a lot about what will prompt someone to open (or point and click on) the document that will result from it. Here are some other insights from our team of clinicians, legal experts, and scholars:

   Assume a messy situation.

   Assume that someone is suffering, and that someone else doesn't
   know how to make the right decision about how to relieve the
   suffering. There may be conflict over this decision, more often
   within the clinical team than within the family.

   Remember that ambivalence is typical in end of life
   decision-making. The medical environment is a hostile environment
   for ambivalence. The legal environment assumes no one is ambivalent
   about these decisions. Public policy around advance directives
   assumes you know exactly what you want and don't want--but later,
   you may be ambivalent about these choices.

   Remember that the person looking for ethical guidance is a person
   in distress.

Our imagined reader is the archetypal "clinician at the bedside." We aim to keep our Guidelines close to the reality of this clinician and the decisions he or she presents to patients and families. …

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