In this period of global struggle as health care professionals are putting their lives on the line, we are pleased to honor five exemplary physicians who specialize in care of patients near the end of life. It seems particularly important to continue this tradition during the coronavirus pandemic. T...

There is a lack of clarity about the New York State Task Force guidelines on ventilator allocation. I believe disability rights concerns regarding the recommendations on chronic ventilator users are well-founded. This lack of clarity may cost lives.

As hospitals and public health authorities devise triage protocols to allocate scarce critical-care resources during the Covid-19 pandemic, people with disabilities are expressing alarm that these protocols devalue them and exacerbate long-entrenched ableism in health care. Lawsuits alleging disability discrimination in have been filed in Washington and Alabama. The U.S. Office for Civil Rights is investigating disability discrimination complaints in triage protocols. The challenge is to develop protocols that will minimize discrimination in the health care system.

A New York Times special report on euthanasia of a Paralympics champion in Belgium was ethically problematic for several reasons.

The Kings County Medical Society in New York recently hosted a brunch with New York State legislators. One of the guests was Richard Gottfried, chair of the New York State Assembly Health Committee, who is cosponsoring A2694, a bill legalizing medical aid in dying (MAID). As a medical oncologist with 30 years’ experience treating seriously ill patients, I have concerns about it, and I expressed them to Gottfried.

Public discussion and policy often cite “aging in place” as a way to improve quality of life and reduce costs of older people. However, in part because of socioeconomic differences and structural inequalities, not all older adults can live in or move to age-supportive communities, neighborhoods, or homes that match their values and needs.These challenges are the focus of a public event cosponsored by The Hastings Center and the Harvard Joint Center for Housing Studies.

Kathy Brandt, a leader in the hospice and palliative care movement in the United States, died on August 4. She was 53 and had been diagnosed with a rare, highly aggressive form of ovarian cancer in January. Brandt and her wife regularly posted on social media about their family's end-of-life experiences.

In a new essay in the Health Affairs Blog Grantswatch, Hastings Center research scholar Nancy Berlinger and president Mildred Z. Solomon offer a glimpse of the Center’s major new research agenda on the ethics of population aging, with a focus on the precarity of older adults, questions of justice, and issues of personal choice. The work is made possible by a generous grant to The Hastings Center from The Robert W. Wilson Charitable Trust as part of its visionary support for the Center’s research and public engagement on ethical challenges facing aging societies.

As the American population ages and dementia is on the rise, The Hastings Center is embarking on pathbreaking research to explore foundational questions associated with the dementia trajectory and the concerns of persons facing this terminal condition. This new research is made possible by a major g...

Should religion play a role in a doctor's care of seriously ill patients? The author, a hematologist/oncologist who teaches Jewish medical ethics, writes: "A physician's outlook may be shaped by religious standards without having to impose it on the patient."

Should an elderly person in decent health but "tired of life" be able to die with a physician's assistance? The Netherlands is grappling with this question.

“Improving patient experience” has become the mantra of many health care facilities in a highly competitive and regulated environment. But just what is it about the patient experience that needs to be improved?  Will better food and gift bags do the trick? Or are more basic changes required?

Four articles in the Hastings Center Report make an array of claims about  whether advance directives should or should not be used to instruct caregivers to withhold oral feeding of a person who reaches a designated stage of  dementia. I would like to advance some central ethical observations on th...

In “Avoiding Deep Dementia,” an essay in the current issue of the Hastings Center Report, legal scholar Norman Cantor explains why he has an advance directive that calls  for voluntary stopping of eating and drinking as a means of ending his life if he develops dementia and reaches a particular ...

Twice upon a time, there was a girl who died. The death certificate that New Jersey issued to 17-year-old Jahi McMath on June 22 was the second one issued for her. California issued McMath’s first death certificate in December 2013.  McMath had been admitted to Children’s Hospital Oakland on...

Dying cannot be understood properly, or responded to well, without recourse to the connections between the dying experience and the larger social structures that make up a social and civic community. To develop this perspective further, it is important to envision a new kind of palliative care system...

In an earlier piece, “Trumping Drug Costs,” I looked at out-of-pocket costs as the pivotal issue with drugs. They can be a particularly heavy burden on the elderly, taking money from their savings and a large bite of their Social Security income. Along the way, I also looked at out-of-pocket medi...

It’s a little-known and rarely discussed fact of medical practice that doctors value the ability to love our patients. If the thought of doctors loving patients makes you queasy, be reassured. I’m not talking about romantic love but the visceral sense of goodwill and impulse to service that draws...

That question was the focus of  “Long Term Care in New York City, circa 2030,” a panel discussion hosted by the New York City Bar Association on May 3 that included Hastings research scholar Nancy Berlinger. In 2030, one million New Yorkers will be age 65 or older. This trend is consistent worl...

Last month, Hawaii became the seventh state, with the District of Columbia, to legalize physician-assisted suicide. Similar to some of the other state laws, Hawaii’s Our Care, Our Choice Act permits competent adults with a terminal illness and a diagnosis of less than six months to live to obtain a...

The death of former first lady Barbara Bush at age 92 was noteworthy in many ways. She was by all accounts smart, sharp and funny, and a fine, helpful wife to one president and mother to another. Her death last week after a long illness, with her husband at her side, was a model of palliative care su...

While the U.S. system of organ donation and transplantation is in a state of growth for the fifth year in a row, the call for new strategies to accelerate that progress has never been more robust as the critical need for transplantable organs continues to far exceed the supply. In an article in the M...

A physician who founded a pediatric palliative care program and another who developed a nationally recognized curriculum to improve communication between doctors and patients with advanced kidney disease are among the five recipients of the 2018 Hastings Center Cunniff-Dixon Physician Awards.

I have been opposed to physician-assisted death for well over 30 years. I need to go back to my early days with this issue to lay out some of my reflections and misgivings. It had long been the case, I was told in 1970, that if one had the right connections and savvy one could easily find a doctor in...

Hastings Center research scholar Nancy Berlinger and cofounder and President Emeritus Daniel Callahan  participated in a major public workshop on February 12 and 13.

Little noticed in the United States but a big deal in France, President Emmanuel Macron announced in January that he is creating a bioethics commission to review the country’s policies on a wide range of subjects, including human reproduction, euthanasia, neuroscience, and artificial intelligence. ...

Is it appropriate for physicians to help patients end their lives? In the current issue of Southern Medical Journal, Hastings Center cofounder Daniel Callahan and Lydia S. Dugdale, an associate professor at Yale School of Medicine, argue that this practice threatens the public good.

“Death with dignity” for the past 40 years has meant, for many people, avoiding unwanted medical technology and dying in a hospital.  A “natural” death at home or in a hospice facility has been the goal.   During the last 20 years, physician-assisted suicide has been legalized for terminal...

A woman juggles caring for her aged father at home and going to work. A volunteer cares for an 83-year-old man who lives alone and wonders why the man’s son doesn’t take more of an interest. Staff members at a nursing home, discussing a patient with dementia who hits staff members, wonder if it�...

Reading “After DNR: Surrogates who persist in requesting cardiopulmonary resuscitation” in the Hastings Center Report, I was reminded of Senate Majority Leader Mitch McConnell’s chastisement of Senator Elizabeth Warren’s opposition to Jeff Sessions’ nomination as Attorney Genera...

It’s unusual for a funder to recognize that large societal problems are best addressed after deep reflection and a deliberate and inclusive process of consultation and priority-setting.  “But then,” says Mildred Z. Solomon, president of The Hastings Center, “The Robert Wilson Charitable Trus...

They may have suffered devastating brain damage due to traumatic injury, or oxygen deprivation to the brain following a heart attack or stroke. They may be awake but not aware (in a vegetative or unresponsive wakefulness state) or awake but minimally aware (minimally conscious state).  Such prolonge...

The new Aspen Health Strategies Group (ASHG), formed by the Aspen Institute, just issued an important report recommending five critical ways to improve care near the end of life.  Hastings Center president Mildred Solomon was one of four national experts invited to advise the Aspen group and develop...

Death is beginning to show its age, though I hesitate to even mention that possibility.  With an obviously big ego and its intimidating black cloak and scythe, it has always had some less than endearing traits: its doggedness pursuit of the aging, but also its sudden and often unpredictable destruct...

An old woman desperately needs medical attention. Yet she fiercely refuses every offer of help from friends, neighbors, and the local doctor. No one will get past her door, she vows. Respecting her autonomy means leaving her alone, possibly to die. Intervening to save her means risking her wrath and ...

Ms. Rita, whom I met as a volunteer at a local nursing home, was the most ardent lover of grapes I have ever known. She was confined to a wheelchair but she never confined herself to her room, choosing instead to wheel around the halls of her new home, a much duller environment than the exciting New ...

Sometime around my mid-50’s I began to ask myself a question: how long should I want to live? My father had died at 64, my mother at 85, my various uncles and aunts in their 60s and 70s. Occasional news stories, always with a picture, reported on those few people who made it to 100. I am now 85 an...

A new chapter in efforts to secure legal provisions for physician-assisted dying began last week when the California State Legislature voted to approve the End of Life Option Act. If Governor Jerry Brown signs the bill, California will become the fifth state to permit physician-assisted dying throu...

We science-medicine-poetry junkies, along with a sizeable portion of the world’s population, are mourning the death of Oliver Sacks, the neurologist and author who died last Sunday from metastasized melanoma. And as enthusiasts of Dr. Sacks’ catechisms on the soul of the patient, we turn to his...

I spent last week in Singapore, where an excellent breakfast of noodles and teah o ais limau (Malaysian-style iced tea with lemon) costs about $2 and is served at an open-air hawker center in under 10 seconds. Observing this Singaporean balance of efficiency, quality, and cost, made possible by the...

Having read with interest Josephine Johnston’s essay on the aid-in-dying case before a court in New Zealand, I’d like to elaborate on some salient points. I have been actively involved with Oregon’s Death with Dignity Act for 14 years, and there are three misconceptions that warrant clarificat...

A 78-­year­‐old Iowa man, Henry Rayhons, has been charged with third­‐degree felony sexual abuse for having sex with his wife, who had severe Alzheimer’s, in her nursing home on May 23, 2014. Mrs. Rayhons died in August. The case raises questions about the capacity to consent in cases of se...

Time is running out on fixing the way we die. As readers of this blog know, the courts first declared a right to refuse unwanted life-sustaining treatment in the 1976 Quinlan case. Nearly four decades later, too many people are still burdened with treatments they don’t want, can’t get support f...

In her New York Times article of January 20, “Complexities of Choosing an End Game for Dementia”, Paula Span reviewed the use of advance directives to withhold food and water as a way of avoiding living long into dementia. She wrote that “ethicists, lawyers and older adults themselves have b...

Brittany Maynard, the courageous 29-year-old woman with terminal brain cancer, ended her life a month ago today. She and her husband had moved to Oregon so that Maynard could take advantage of that’s state’s Death with Dignity law. Although Maynard fit squarely into Oregon’s criteria and her d...

Death is hard to deal with anywhere, but France has some contradictory ways of providing end-of-life care, as two recent articles discuss.

Recently, I spoke with a seasoned health care reporter who was interested in Alzheimer’s and biomarkers because of his own family’s history of this disease. He started by asking, “Why would anyone not want to take this test?” – to “know,” so they could “plan”  – and then soon ack...

I recently gave a talk about Alzheimer’s disease and asked people to imagine two individuals, Manny and Sue. Manny died at 85; he was showing signs of age but living independently and was mentally “all there.” Sue lived until 99. From the time she was 88, she began a slow cognitive decline. By ...

Two cases involving “brain death” have received considerable public attention, including commentary by several well-known bioethicists. In commenting on these cases the bioethicists have stated, in no uncertain terms, that an individual correctly diagnosed as “brain dead” is dead, pure and si...

Brain death is an immensely challenging concept to grasp, even for health care providers. The patients look like any other patient in the intensive care unit; they have vital signs, they are warm, sometimes their extremities even reflexively respond to stimulation. We turn them, we empty their drains...

Family Lose Right-to-Life Case at U.K.’s Highest Court.” “Judges ‘Right’ to Allow Man to Die.” “Widow Loses ‘Withdrawn Treatment’ Case.” These were the headlines on a recent Supreme Court decision in the U.K. about end-of-life decision-makin...

 There is a saying in ethics: you can’t get an “ought” from an “is.” Descriptions of the world as it is do not reveal truths about the world as it ought to be. Even when descriptions of real-world conditions suggest that something is seriously wrong — that our actions are causing uninten...

My sister called: “Get the orange card out of my wallet on the table. We need to call the study people.” In July, we got the news – Dad’s colon cancer was back. He had a six-month prognosis, so we began the planning: a big 95thbirthday party, caregiving schedule, trips to the doctor. Sinc...

The problems with end-of-life care are clear enough. Patients and their families/significant others still have trouble talking with one another and their doctors about how they would and would not want to spend their final days. All too often, for many reasons, patients’ wishes are not honored. Ove...

Armond and Dorothy Rudolph of New Mexico were evicted from their assisted living facility in January 2011, after administrators called the police and rescue workers and informed them the couple, who were in their early 90s, were attempting suicide. A chaotic scene ensued and the Rudolphs were permitt...

Goldilocks, all grown up and working as a Medicare hospice auditor, checks the records of three patients.  She frowns at Mr. Brown Bear’s record.  He was referred to hospice three days before he died, after spending several costly weeks in an acute care hospital, the last two in an intensive care...

Belgian twins, Eddie and Marc Verbessem, were euthanized by lethal injection at Brussels University Hospital in Jette in December. The Verbessem brothers, deaf since birth, were cobblers by trade who lived and worked together their entire lives. Several years ago they were diagnosed with a genetic ...

For some years I have been writing about end-of-life care and, of late, focusing on the high costs of that care. I recently had a painful but revealing insight into what the future might look like on both costs and decision-making. It came about from an unexpected angle of vision,  the care provi...

On February 5, Lisa Krieger, a science and medicine writer for the Mercury News in San Jose, Ca, published a remarkably moving and insightful article about the protracted dying of her 88-year-old father. Suffering from advanced dementia he contracted septicemia, was admitted to the ICU of the Sta...