The Function and Sources of These Ethics Guidelines -- Legal and Ethical Consensus Informing These Guidelines: Rights, Protections, and Key Philosophical Distinctions

Pt. One. Framework and Context. Ethics Goals for Good Care When Patients Face Decisions about Life-Sustaining Treatment or Approach the End of Life -- Section 2 Ethics Education Competencies for Health Care Professionals Caring for Patients Facing Decisions about Life-Sustaining Treatment or Approaching the End of Life -- Section 3 Organizational Systems Supporting Good Care and Ethical Practice -- Section 4 Social, Economic, and Legal Contexts -- A.Social Context -- B.Economic Context -- C.State and Federal Context

Pt. Two Guidelines on Care Planning and Decision-Making. Section 1 Guidelines for Advance Care Planning and Advance Directives: Using Patient Preferences to Establish Goals of Care and Develop the Care Plan -- Section 2 Guidelines for the Decision-Making Process -- A.Evaluating the Patient -- B.Determining Decision-Making Capacity -- C.Identifying the Key Decision-Maker -- D.Surrogate Decision-Making -- E.Making the Decision at Hand -- F.Documenting the Decision -- G.Implementing the Decision -- H.Changing Treatment Decisions -- I.Conflicts and Challenges Related to Treatment Decision-Making

Section 3. Guidelines Concerning Neonates, Infants, Children, and Adolescents. A.General Guidelines for Pediatric Decision-Making Concerning the Use of Life-Sustaining Treatments -- B.Guidelines for Decision-Making and Care Involving Nonviable Neonates and Neonates at the Threshold of Viability -- C.Guidelines for Decision-Making about Life-Sustaining Treatment for Viable Neonates -- D.Guidelines for Decision-Making about Life-Sustaining Treatment for Young Children -- E.Guidelines for Decision-Making with Older Children -- F.Guidelines for Decision-Making with Adolescents -- G.Guidelines for Decision-Making by Mature Minors and Emancipated Minors

Section 4. Guidelines for Care Transitions. A.General Guidelines for Hand-Offs between Professionals and Transfers Across Care Settings -- B.Guidelines on Care Transitions for Nursing Home Residents -- C.Guidelines on Portable Medical Orders -- D.Guidelines on Discharge Planning and Collaboration with Nursing Homes, Home Care, Hospice, and Outpatient Care -- E.Guidelines on Care Transitions for Patients Who Will Die in the Hospital

Section 5. Guidelines for the Determination of Death. A.Procedural Guidelines for Making a Determination of Death and for Making a Declaration of Death -- B.The Determination of Death: Continuing Ethical Debates

Section 6 Guidelines for Institutional Policy. A.Guidelines on Ethics Services in Institutions Providing Care for Patients Facing Decisions about Life-Sustaining Treatment on Approaching the End of Life -- B.Guidelines on Palliative Care Services -- C.Guidelines Supporting Advance Care Planning -- D.Guidelines Supporting Portable Medical Orders -- E.Guidelines Supporting Care Transitions -- F.Guidelines on the Role of Institutional Legal Counsel and Risk Management in Supporting Good Care -- G.Guidelines on Conflict Resolution

Pt. Three. Communication Supporting Decision-Making and Care. Section 1 Communication with Patients, Surrogates, and Loved Ones -- A.Conducting a Family Conference When a Patient's Condition Is Deteriorating -- B.Supporting the Decision-Maker When Loved Ones Disagree -- C.Discussing Values Concerning Nutrition and Hydration -- D.Using Electronic and Telephone Communications with Seriously Ill Patients or with Surrogates and Loved Ones

Section 2. Communication and Collaboration with Patients with Disabilities. A.Life-Sustaining Treatments and Accommodation of Stable or Progressive Disabilities -- B.Communication When a Patient's Disability Affects Speech -- C.Communication When a Patient's Disability Affects Cognition -- D.Communication and Collaboration with Recently Disabled Patients Concerning Life-Sustaining Treatments

Section 3. Psychological Dimensions of Decision-Making about Life-Sustaining Treatment and Care Near the End of Life. A.Coping as a Factor in Treatment Decision-Making -- B.Hope as a Factor in Treatment Decision-Making -- C.Ambivalence, Denial, and Grief as Factors in Treatment Decision-Making -- D.Existential Suffering as a Factor in Treatment Decision-Making -- E.Spirituality and Religion as Factors in Treatment Decision-Making -- F.Religious Objections During Treatment Decision-Making -- G.Moral Distress as a Factor in Treatment Decision-Making -- H.Integrating Bereavement Care for Loved Ones and Professionals into Care Near the End of Life

Section 4. Decision-Making Concerning Specific Treatments and Technologies. A.Forgoing Life-Sustaining Treatments: Ethical and Practical Considerations for Clinicians -- B.Brain Injuries and Neurological States -- C.Mechanical Ventilation -- D.Cardiopulmonary Resuscitation and Cardiac Treatments -- E.Dialysis -- F.Nutrition and Hydration -- G.Chemotherapy and Other Cancer Treatments -- H.Routine Medications, Antibiotics, and Invasive Procedures -- I.Blood Transfusion and Blood Products -- J.Palliative Sedation

Section 5. Institutional Discussion Guide on Resource Allocation and the Cost of Care. A.Developing a Practice of Discussing Resource Allocation and the Cost of Care: Six Strategies -- B.Discussing Uncompensated Care for Patients Without Insurance.