Selected Issues > End of Life
End of Life

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Death may not have changed, but dying is quite different from what it used to be, thanks to medical technologies that have extended life and made dying frequently a lingering process rather than a sudden event.  People with failing kidneys can survive on dialysis for 20 or more years. People with incurable cancer can live for months or years with chemotherapy and radiation treatments. Victims of car accidents who would once have died of head trauma can now be kept alive by ventilators and feeding tubes. In the meantime, life-saving therapies for what were once sudden killers, like heart attack, mean that increasing numbers of people who end up with chronic complications or decline into dementia.
From the Hastings Center

2012 July-August

Reality Checks

by April R. Dworetz
Giving up on our dreams is not easy. I know this, but I didn’t really understand it until I lived it.

News

Physicians Honored for Exemplary End-of-Life Care by Hastings Center Cunniff-Dixon Awards

A surgeon and a pediatrician are among the four American physicians who have done exceptional work in end of life care and were named today as recipients of the first Hastings Center Cunniff-Dixon Physician Awards. The awards were given by the Cunniff-Dixon Foundation, whose mission is to enrich the doctor-pa

Bioethics Briefing Book

End of Life Care

By Alan Meisel

News

Surgeon and Hospice Founder Accepts Hastings Center Cunniff-Dixon Physician Award

Robert A. Milch, MD, FACS , a surgeon who helped found Hospice Buffalo, one of the nation’s early hospices, received the inaugural Hastings Center Cunniff-Dixon Physician Award for leadership in care near the end of life at a ceremony at The Center for Hospice & Palliative Care near Buffalo on Januar

2009 May-June

The Evolution of Death and Dying Controversies

By Robert M. Veatch
When The Hastings Center began its death and dying work in 1970, the first task was to disentangle the definition of death from decisions to forgo life support. We were still in an era when it was often assumed that if one was alive, then health professionals should launch a full-court press to preserve life. Early on, the Center’s Task Force on Death and Dying recognized the crucial public, social, psychological, and legal significance of a categorical distinction between life and death. But with forty years of hindsight, it is remarkable how simple the definition-of-death debate seemed back then. In contrast, the controversies surrounding forgoing of life-support have sometimes turned out to be more easily resolved.

2009 March-April

Substituting Authenticity for Autonomy

By Rebecca Dresser
Choosing for incapacitated patients is a major challenge in medicine. Scholars and policy-makers have struggled for years to explain and justify various approaches to determining appropriate treatment for such patients. In this issue, Daniel Brudney makes an important contribution by clarifying a conceptual confusion in the common understanding of the substituted judgment standard. He argues that unlike decisions expressed in advance directives, decisions based on what the patient would want fail to promote self-determination. Instead, they promote authenticity. This is a novel account of why inferred treatment choices are distinct from choices expressed by patients themselves.

2009 March-April

Complicating the Story

By Gregory E. Kaebnick
Both articles in this issue of the Hastings Center Report try to complicate the standard view of how health care decisions are made at the end of life. In the lead article, philosopher Daniel Brudney argues that self-determination cannot do nearly as much work as the standard view supposes, and in the second article, legal scholar Robert Burt argues that even when the patient can express preferences directly, decision-making should be much more complex than the standard model allows.

Books

Ethical Dilemmas at the End of Life

Edited by Bruce Jennings, Kenneth J. Doka, and Charles Corr Written and edited by some of the nation’s leading authorities on ethics and end of

Resources

A Conversation with Robert Milch

A conversation with Robert A. Milch, MD, FACS
Dr. Milch is the inaugural winner of the Hastings Center Cunniff-Dixon Established Physician Award for excellence in clinical care for patients near the end of life and national leadership in palliative care.

Cunniff-Dixon Foundation: The art of medicine near the end of life

The Center on Human Policy, “A Statement of Common Principles On Life-Sustaining Care and Treatment of People With Disabilities”