Avoiding harm and improving care near the end of life: what good can ethics do? (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)

Patient care situations in which there is uncertainty about how to relieve suffering, make medical decisions on behalf of others, work with families in conflict, resolve disagreements among team members, or respond to institutional priorities and pressures are frequently described as ethically challenging situations. Why do these situations present themselves so often in care near the end of life? How can "ethics," including clinician education, ethics consultation services, and institutional policy development, help professionals and organizations involved in the care of seriously ill patients to anticipate these challenges, avoid harms, and prevent care problems? As our nation's health care system changes, what steps should we take to improve care near the end of life? The publication of a new edition of the landmark Hastings Center Guidelines offers an opportunity to explore these questions.