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The Hastings Center Guidelines on End-of-Life Care

Project launched in January 2007

Project Website:

Project DirectorNancy Berlinger

Project Consultants:Bruce Jennings and Susan Wolf

Funders: The Albert Sussman Charitable Remainder Annuity Trust and the Patrick and Catherine Weldon Donaghue Medical Research Foundation; additional support was provided by the donors to The Anika Papanek Memorial Fund at The Hastings Center 

Project Goals and Objectives

The Hastings Center has revised, updated, and expanded its historic publication, Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying (1987). The new publication is Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life (Oxford University Press, 2013). 

The goal of the publication is to improve the quality of end of life care in the United States by providing ethical guidelines for the current generation of health care professionals on the decisions dying patients, their families, and other caregivers may face. It reflects 25 years of empirical research, clinical innovations, legal and policy developments, and evolution of professional consensus concerning the practices and systems that can support ethically sound treatment decision-making and the deliveray of safe, effective, and compassional care near the end of life. It also describe the practices, policies, and other systems that support communications and decision making and promote access to palliative care, hospice care, and other services.

For more information about the Guidelines project, see or contact Nancy Berlinger,

The Hastings Center Guidelines on End of Life Care: Working Group

Adrienne Asch, PhD, MS, is the Edward and Robin Milstein Professor of Bioethics at Wurzweiler School of Social Work, professor of epidemiology and population health at Albert Einstein College of Medicine, and Director of the Center for Ethics at Yeshiva University. She was a contributor to Improving End of Life Care: Why Has It Been So Difficult? (The Hastings Center, 2005).

Raymond Barfield, MD, PhD is a pediatric oncologist-hematologist at Duke University Medical Center, where he directs the Pediatric Quality of Life Program. He also holds an appointment in Duke's divinity school, where he is affiliated with the Duke Institute on Care at the End of Life. Before coming to Duke in 2000, he was a bone marrow transplanation specialist at St. Jude Children's Research Hospital.

Susan Block, MD, is chief of the division of psychosocial oncology and palliative care at Dana-Farber Cancer Institute and Brigham and Women’s Hospital, codirector of the Harvard Medical School Center for Palliative Care, and professor of psychiatry at Harvard Medical School.

Robert A. Burt, JD, is Alexander M. Bickel Professor of Law at Yale Law School.  He is the author of Death Is That Man Taking Names: Intersections of American Medicine, Law and Culture (University of California, 2002) and was a coauthor of Improving End of Life Care: Why Has It Been So Difficult? (The Hastings Center, 2005).

  Julia Connelly, MD is a geriatrician who since 1990 has been Medical Director at the Orange County Nursing Home in rural Virginia and a professor of internal medicine at the University of Virginia Medical School, where she co-directs UVA's Humanities in Medicine program.

Nessa Coyle, NP, PhD, is a member of the pain and palliative care service of Memorial Sloan-Kettering Cancer Center. She is the coeditor, with Betty Ferrell, of the Textbook of Palliative Nursing (Oxford, 2nd ed., 2005).

J. Randall Curtis, MD, MPH, is professor of pulmonary and critical care medicine at the University of Washington in Seattle and director of the Harborview Medical Center/University of Washington End-of-Life Research Program. He is coeditor of Managing Death In the ICU: The Transition From Cure to Comfort (Oxford, 2001).

Nancy Neveloff Dubler, LLB, is the former director of the division of bioethics, department of family and social medicine, Montefiore Medical Center, where until her retirement in 2008 she directed the clinical ethics consultation service, and served as professor of bioethics at the Albert Einstein College of Medicine. She was a coauthor of Improving End of Life Care: Why Has It Been So Difficult? (The Hastings Center, 2005).

Linda Emanuel, MD, PhD, is director of the Buehler Center on Aging, Health & Society at the Feinberg School of Medicine at Northwestern University. She is the founder and principal of the Education for Physicians in End-of-life Care (EPEC) project and established the Institute for Ethics at the American Medical Association. She was a coauthor of Access to Hospice Care: Expanding Boundaries, Overcoming Barriers (The Hastings Center, 2003).

Betty R. Ferrell, RN, PhD, is a research scientist in nursing research and education at the City of Hope Medical Center, principal investigator of the End-of-Life Nursing Education Consortium (ELNEC), and coeditor, with Nessa Coyle, of the Textbook of Palliative Nursing (Oxford, 2nd ed., 2005). She was a member of the review committee for the National Quality Forum's Framework and Preferred Practices for Palliative and Hospice Care (2007).

Joseph J. Fins, M.D, FACP, is Chief of the Division of Medical Ethics and Professor of Medicine, Professor of Public Health and Professor of Medicine in Psychiatry at Weill Medical College of Cornell University, and a member of the adjunct faculty of Rockefeller University. He is also director of medical ethics at New York Presbyterian Hospital/Weill-Cornell Medical Center and the author of A Palliative Ethic of Care: Clinical Wisdom at Life's End (Jones and Bartlett, 2006).

George Fitchett, DMin, PhD, is Director of Research and Associate Professor, Department of Religion, Health, and Human Values, at Rush University Medical Center. He has conducted numerous studies of chaplains and their work, developed spiritual assessment tools for clinical use, and collaborated with clinical researchers from medicine and nursing to investigate interdisciplinary questions related to spiritual care.

Alan Fleischman, MD, is Senior Vice President and Medical Director of the March of Dimes Foundation, having been a March of Dimes supporter and volunteer for over 20 years. He is also Chair of the Federal Advisory Committee to the National Children’s Study at the National Institute of Child Health and Human Development, NIH, and Clinical Professor of Pediatrics and Clinical Professor of Epidemiology and Population Health at the Albert Einstein College of Medicine in New York.

Kathleen Foley, MD, is an attending neurologist in the pain and palliative care service at Memorial Sloan-Kettering Cancer Center, where she holds the Chair of the Society of Memorial Sloan-Kettering Cancer Center in Pain Research.  She was a coauthor of Improving End of Life Care: Why Has It Been So Difficult? (The Hastings Center, 2005).

Carlos Gomez, MD, PhD, is the medical director for the District of Columbia Pediatric Palliative Care Collaboration. He was profiled in the Bill Moyers’s documentary, On Our Own Terms: Moyers on Dying (PBS, 2000).

 Sandra H. Johnson, JD, LLM, holds the Tenet Endowed Chair in Health Law and Ethics at Saint Louis University School of Law and Center for Health Care Ethics. She directed the Mayday Project on Legal and Regulatory Issues in Pain Relief at the American Society of Law, Medicine, and Ethics from 1996-2006.  She was a coauthor of Improving End of Life Care: Why Has It Been So Difficult? (The Hastings Center, 2005).  She is coeditor-in-chief of the Journal of Law, Medicine & Ethics.

Kristi L. Kirschner, MD, is former Director of the RIC Donnelley Family Disability Ethics Program, and since January 2010 has moved to Northwestern University Feinberg School of Medicine’s Medical Humanities and Bioethics Program, where she is a Professor of Clinical Medical Humanities and Bioethics. She holds a secondary appointment in the Department of Physical Medicine and Rehabilitation, and also now practices at Schwab Rehabilitation Hospital.

Alan Meisel, JD, is professor of law, Dickie, McCamey & Chilcote Professor of Bioethics, and director of the Center for Bioethics and Health Law at the University of Pittsburgh. He served on the President’s Commission for the Study of Ethical Issues in Medicine and Biomedical and Behavioral Research and participated in the authorship of its report, Deciding to Forego Life-Sustaining Treatment. He is the principal author of the legal treatise, The Right to Die: The Law of End-of-Life Decisionmaking (Aspen., 3rd ed., 2004) and was a coauthor of Improving End of Life Care: Why Has It Been So Difficult? (The Hastings Center, 2005).

Richard Payne, MD, is Esther Colliflower Director of the Duke Institute on Care at the End of Life and professor of medicine and divinity at Duke Divinity School. His publications include the Institute of Medicine report, Approaching Death: Improving Care at the End of Life (1997).

Gloria Ramsey, RN, JD, is associate professor in the graduate school of nursing and director of community outreach and information dissemination at the Center for Health Disparities Research and Education at the Uniformed Services University of the Health Sciences.

Charles P. Sabatino, JD, is the director of the American Bar Association’s Commission on Law and Aging. He is the lead author of the American Bar Association Legal Guide for Older Americans (Random House, 1st ed., 1998).

Colleen Scanlon, RN, MS, JD, is senior vice president for advocacy at Catholic Health Initiatives in Denver, Colorado. She served on the coordinating council of the National Center for State Courts Project on End-of-Life Decision Making, which produced the book Resolving Disputes Over Life-Sustaining Treatments (1996).

Mildred Z. Solomon, EdD, is president and CEO of The Hastings Center and clinical professor of Anaesthesia at Harvard Medical School, where she directs the Fellowship in Medical Ethics.

Daniel Sulmasy, OFM, MD, PhD, is a Franciscan friar, the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago, and also serves as associate director of the MacLean Center for Clinical Medical Ethics. Dr. Sulmasy’s most recent books are The Rebirth of the Clinic (Georgetown, 2006) and A Balm for Gilead: Meditations on Spirituality and the Healing Arts (Georgetown, 2006). He was a coauthor of Access to Hospice Care: Expanding Boundaries, Overcoming Barriers (The Hastings Center, 2003).

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