Table 1.

ACEP Policy Statement: Ethical Issues at the End of Life

The American College of Emergency Physicians believes that:

Emergency physicians play an important role in providing care at the end of life (EOL). Helping patients and their families achieve greater control over the dying process will improve EOL care. Advance care planning can help patients formulate and express individual wishes for EOL care and communicate those wishes to their health care providers by means of advance directives (including state approved advance directives, DNAR orders, living wills and durable powers of attorney for health care).

To enhance EOL care in the ED, the American College of Emergency Physicians believes that emergency physicians should:

Respect the dying patient's needs for care, comfort, and compassion. Communicate promptly and appropriately with patients and their families about EOL care choices, avoiding medical jargon. Elicit the patient's goals for care before initiating treatment, recognizing that EOL care includes a broad range of therapeutic and palliative options. Respect the wishes of dying patients including those expressed in advance directives. Assist surrogates to make EOL care choices for patients who lack decision making capacity, based on the patient's own preferences, values, and goals. Encourage the presence of family and friends at the patient's bedside near the end of life, if desired by the patient. Protect the privacy of patients and families near the end of life. Promote liaisons with individuals and organizations in order to help patients and families honor EOL cultural and religious traditions. Develop skill at communicating sensitive information, including poor prognoses and the death of a loved one. Comply with institutional policies regarding recovery of organs for transplantation. Obtain informed consent from surrogates for postmortem procedures.