The most important thing to remember about planning for your end-of-life care is that you have the power to determine the kind of treatments you want to receive and the kind of treatments you want to avoid. Whether you’re just getting started on this journey of understanding your choices and making a plan, or you’ve been clear for awhile, we encourage you to take time to review the options below and discuss with your physician so you can feel secure about your choices now and in the future.
CPR (cardiopulmonary resuscitation) – is used when someone’s heart or breathing stops and includes chest compressions and rescue breathing and is considered an emergency life- saving procedure.
Artificial hydration/nutrition – is used to sustain life when someone can no longer eat or drink on his or her own. A tube is placed directly into the stomach, intestine or vein to provide an adequate amount of nutrition and hydration for life. This is often referred to as a feeding tube. Read these Questions and Answers: Artificial Nutrition and Hydration and End of Life Decision Making from WebMD.
There can be significant emotional burdens tied to the decision to insert a feeding tube. There can also be physical issues associated with having a feeding tube, especially for those who may be within their last few weeks of life or have dementia. Learn more about the benefits and possible complications of artificial hydration/nutrition on WebMD.
Intubation/mechanical ventilation– is a life-sustaining procedure that entails inserting a tube into the windpipe to provide a way to get air into the lungs artificially through a breathing machine. Some of the complications associated with mechanical ventilation include infection, lung damage, and side effects of the medications given for sedation. Please discuss more with your physician about mechanical ventilation. Learn more about intubation from the National Institutes of Health.
Medications (including antibiotics) – emergency medications are often given by medical professionals to assist with CPR efforts to sustain life. Antibiotics are medications given to fight infections. Some people opt to have antibiotics but not emergency medications. The choice is yours and should be discussed with your physician.
Dialysis – is needed when a person’s kidneys stop functioning to the point that toxins build up inside the body. Dialysis helps to remove these toxins. Dialysis is usually required on a frequent basis and may be associated with side effects of low blood pressure, shortness of breath, and chest pain. Ask your physician to explain more about dialysis. Read more about kidney dialysis at WebMD.
According to recent research, many people prefer the comfort of their own home when seriously ill and near the end of life. However, others feel more comfortable in the hospital setting knowing that medical technology and professionals are readily available to care for them.
Limited Medical Treatment
Managing Pain and Mental Well-Being through Palliative Care
Palliative care can be provided in conjunction with curative medical treatments. One of the comments often made by people is how they want to limit pain and discomfort should they become very ill. One of the options for managing a chronic, debilitating illness is through palliative care which focuses on providing patients relief from symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression among many others. The goal of palliative care is to improve a patient’s quality of life. It is important to ensure mental and emotional health is being addressed when someone is very sick or living with a chronic illness.
As one nears their end of life, it is important to understand the importance of being comfortable, not just physically, but also emotionally, mentally and spiritually. To learn more about comfort care when someone is dying visit National Institute on Aging.
Hospice is a concept of care designed to provide comfort and support to patients and their families with a life-limiting illness. Hospice is patient and family-centered care, typically associated with care in the last six months of a person’s life.
The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity and by addressing all symptoms of a disease, with a special emphasis on offering relief from pain and suffering. Hospice care neither prolongs life nor hastens death.
The care is provided by an interdisciplinary team of specially trained professionals and volunteers who provide support for the patient and their family. Hospice services are provided on an intermittent basis, but services are available 24 hours a day, 7 days a week to provide support and care to patients and family members and is sensitive to the patient’s personal, cultural and religious values, beliefs and practices. Hospice addresses the emotional, social and spiritual impact of the disease on the patient and the patient’s family and friends. Hospice offers a variety of bereavement and counseling services to families before and after a patient’s death.
To learn more about Washington State Hospice and Palliative Care – http://www.wshpco.org/
To learn more about National Hospice and Palliative Care – http://www.nhpco.org/about/hospice-care
POLST (Physician Orders for Life Sustaining Treatment)
When someone is seriously ill, they can make decisions about life-sustaining treatment before the patient is no longer able to make these decisions. Once these wishes have been discussed with the physician, they can be transformed into medical orders called POLST.
Do Not Resuscitate Orders (DNR)
This is an order written by the doctor to direct medical professionals to not initiate CPR (cardiopulmonary resuscitation) should a person stop breathing or heart stops. It is an order you choose should an emergency arise and you do not want to have resuscitation. This order only applies to CPR and does not apply to medications or other treatments. Learn more about Do Not Resuscitate Orders from the Visit National Institutes of Health.
Sometimes not knowing where to start or what to ask your health care provider can be daunting. As with all care decisions, it’s important to discuss your options – including risks and benefits — with your physician. Here are a few questions to consider:
- What are the side effects?
- What affect will this treatment have on my quality of life?
- What are the infection rates?
- Will I be able to spend time with my family if I have this treatment?
- How much time will I be able to spend at home versus in a care setting with proposed treatment?