The criteria for the awards have been established by The Hastings Center Selection Committee, which was convened specifically for this purpose. The criteria are five fold.
1. Technical competence
Competence is a baseline requirement. It encompasses both technical knowledge of the best means of palliative care, medical and pharmaceutical, as well as skill in determining how best to deploy this with individual patients. The art of medicine and the science of medicine come into play.
2. Personal integrity
Personal integrity means that combination of personality traits and virtues most conducive to good end-of-life care. Given the frequent medical uncertainty of such care and the individual differences among patients in response to their treatment, humility is a key virtue. That means knowing what one does not know, a willingness to shift modes of treatment when an earlier course proves inefficacious, and a sharing of uncertainty with colleagues.
Friendship with patients, though not always possible, is an advantage. Dying can be lonely. The patient is sometimes bereft of family and friends, and often only the physician is in a position to be a steadfast companion. Availability is hardly less important—being there when a patient needs care, which means having an openness to inconvenience and schedule disruption. A willingness to make house calls to avoid unnecessary visits to hospitals or physician offices is an important mark of availability. Most fundamentally, patients need to know they will not be abandoned. At times, families, in effect, abandon their loved ones, sometimes because they were not close in the first place or because they cannot cope with the reality of a loved one’s dying. But, come what may, the physician must be there until the very end.
3. Doctor-patient dialogue
Good doctoring for patients near the end of life —the art of astute symptom management, knowledge of the science behind it, and physicians’ engagement with the person before them—is what these awards recognize at exemplary levels. The awards exist in three categories: early-career physicians (0-7 years from training), those at mid-career (8-19 years), and those at senior stages. Physicians caring for patients near the end of life understand their patients’ particular circumstances and what they value. Patients need to know what their physicians make of them and to be confident that they will manage their symptoms well and talk with them about various treatment approaches and their limits and drawbacks. Those for whom the end of life is near usually benefit from engaging actively in their care. Minimally, this means they (and often family members or other surrogates) meet regularly with their principal doctors to make plans that balance their goals for individual comfort, function, and longevity. Not all patients (or families) want this kind of knowledge or engagement, at least initially. Good doctoring often includes several conversations with patients, families, and other members of the care team.
4. Active engagement of friends and family
Families are part of the picture, and they often need their own assessment and dialogue. They may or may not know what their loved one said earlier about how he or she wanted to be cared for near the end of life. While a physician may not be well placed to help resolve some problems or tensions between patients and families, they need to be aware of them and devise a plan for addressing them.
5. Ability to function well as part of a care team
Cooperation among caregivers is crucial for good doctoring. Nurses, social workers, and often chaplains, discharge planners, and other physicians are part of the picture. Continuity of care matters hugely. Not only do principal physicians need to spell out for patients and care teams who will be responsible; they also need to assure their patients that they will be there as needed. When patients reside at home, the ability to work well with a team also matters, as nurses and family members provide most home care.