A Good Death

A good death is hard to find. Family members tell us that loved ones die in the wrong place—the hospital—and do not receive high‐quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end‐of‐life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively new and still vulnerable aspect of medical care. For thousands of years, patients and surrogates had no say in medical decision‐making. Today, standards support shared decision‐making, but these articles both carve out exceptions to those standards, limiting the rights of patients and families in decisions about specific end‐of‐life treatments. As bioethics consultants in an acute care setting, we frequently confront conflicts similar to those described by Jeffrey Berger and by Ellen Robinson and colleagues. In such cases, our service emphasizes redoubled efforts at communication and mediation. Focusing on goals and values, rather than interventions, produces the best possible collaboration in health care decision‐making. Cases in which we would overturn a surrogate's recommendations regarding palliative sedation or do‐not‐resuscitate orders are rare and require careful processes and clear evidence that the surrogate's choice is contrary to patient values

Assisted suicide · Bioethics · Do not resuscitate · End-of-life care · Health care · Life Support Care · Limiting · MEDLINE · Palliative care · Political science · Psychiatry · Psychological intervention · Ethics and Legal Issues in Pediatric Healthcare · Ethics in medical practice · Law · Medicine · Nursing · Palliative Care and End-of-Life Issues · Psychology

• Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers

  Karen E Steinhauser•JAMA•2000

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• The Limits of Surrogates’ Moral Authority and Physician Professionalism

  Open Access•Jeffrey T Berger•The Hastings Center Report•2017

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• After the DNR

  Open Access•Ellen Robinson, Ellen M Robinson et al.•The Hastings Center Report•2017

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