Know Your Choices

It is important to understand what some of the treatments are that could prolong your life. Below you will find a description of some common treatments. Be sure to talk to your health care provider about how these treatments and options apply to you.

• CPR (Cardiopulmonary Resuscitation)

  Cardiopulmonary Resuscitation or CPR is a procedure used when your heart or breathing stop. CPR includes a breathing tube to help get oxygen into your body and deep pushing on your chest to move the blood. Electric shock to the heart using a defibrillator or AED may be used. Medications may also be used to restart the heart and help blood flow through the body.

  CPR works best if your body is healthy and CPR is started right after your heart stops. CPR is less likely to be successful if you are weak, elderly, or have a chronic illness.

  Most people do not feel CPR because they are unconscious. Deep compressions can break ribs, causing bruising and pain.

  What are the benefits (help)?

  If CPR is successful, you may return to your current health.

  What are the burdens (harm)?

  If CPR is successful, you may experience complications including:

  • You might need a ventilator (breathing machine) because of weakened lungs.
  • You might have bruised or broken ribs from the chest compressions.
  • You might have brain damage because your brain did not get enough oxygen.

  What if I choose not to have CPR?

  You will still get other medical care you need. Other treatments can keep you comfortable, manage pain, and control symptoms so you can live as well and as long as is possible for your health status. If your heart or breathing stops and you do not receive CPR, you will die naturally.

  How do I decide what is best for me?

  Talk with your doctor and your loved ones about your medical and personal goals and values.

• Artificial Hydration and Nutrition

  Artificial hydration and nutrition (AHN) is a treatment to provide food and water when you have difficulty swallowing or are too sick to eat on your own. It is also known as a tube feeding.

  A feeding tube can be inserted into your nose that goes into your stomach (nasogastric tube) or directly into your stomach (PEG tube) through a small cut your doctor puts in your skin to place the tube into your stomach.

  What are the benefits (help)?

  A feeding tube might be a good idea in cases of illnesses (for example, stroke) where swallowing is affected. The tube might be inserted temporarily where recovery is expected, or permanently where the ability to swallow will not improve enough to return to normal eating and drinking. A person may feel that their quality of life is otherwise reasonable and they would like to have a long term feeding tube.

  What are the burdens (harm)?

  Some side effects can be associated with tube feeding:

  • The need to insert tubes can be uncomfortable, and the tubes may need to be replaced from time to time.
  • Tube feeding can cause stomach distension and discomfort, and too much fluid in the body. The risk of developing pneumonia and breathing issues is usually higher when a feeding tube is used.
  • Sometimes, a feeding tube just prolongs the dying process, and be very distressing for the person and their family. Especially in cases of advanced dementia, there may be a need to use medication to sedate a person, or to restrain their arms so that the person does not pull their tube out.

  What if I choose not to have a feeding tube?

  If you can swallow, you will be fed carefully with a spoon. If you cannot swallow, moist swabs will be used to help if dry mouth occurs. Most people near death do not feel hunger or thirst. You also will still get other medical care you need. Other treatments can keep you comfortable, manage pain and control symptoms so you can live as well and as long as is possible for your health status.

  How do I decide what is best for me?

  Talk with your doctor and your loved ones about your medical and personal goals and values.

• Help with Breathing

  A physical condition or illness may make breathing on your own difficult, painful or impossible. If you have a breathing problem, choices are available to help including:

  • Taking medicine
  • Inhaling oxygen through a tube in your nose or mask over your mouth
  • Using a bi-level positive airway pressure (BiPAP) machine. A BiPAP machine pushes a mixture of air and oxygen into your lungs through a tight-fitting mask over your mouth. The mask may be uncomfortable and make talking difficult. You may receive medicine to help stay calm when wearing the mask. Because you do not have a tube guiding the oxygen directly to your windpipe, sometimes the oxygen can go into your stomach. Oxygen in your stomach can cause discomfort.
  • Being put on a ventilator. A ventilator is a machine that pushes a mixture of air and oxygen in and out of your lungs to breathe for you. The machine connects to a tube that goes through your mouth and down your windpipe at the back of your throat. Inserting this tube down your windpipe is called intubation. When the tube is in place, you cannot talk or swallow. You will receive medicine to help stay calm when the tube is in place. Being on a ventilator requires care in the Intensive Care Unit at the hospital.

  A ventilator or BiPAP work best if you:

  • Have a breathing problem that can be cured
  • Need help with breathing for a short time while recovering from surgery or a sudden illnessA ventilator or BiPAP machine will not work as well if your:
  • Illness can not be cured
  • Body is not able to tolerate the high-pressure flow of the oxygen in and out of your lungs

  What if I choose not to have a ventilator or BiPAP?

  If you are not able to breathe on your own and decide you do not want a ventilator or to use a BiPAP machine, you will die naturally. If this is your choice, you will still get other medical care you need. Other

  treatments can keep you comfortable, manage pain, and control symptoms so you can live as well and as long as is possible for your health status.

  How do I decide what is best for me?

  Talk with your doctor and your loved ones about your medical and personal goals and values.

• Dialysis (Kidney Machine)

  Dialysis is used when your kidneys are no longer working.

  Dialysis helps to remove these toxins that can build up when your kidneys don’t work. It usually requires being connected to a machine for several hours, multiple times per week.

  What are the benefits (help)?

  The potential benefits of dialysis include the possibility of living longer, feeling better and being more mentally alert. For many people, especially for older and sicker people, dialysis is likely to be a lifelong treatment. But in some circumstances the kidneys may improve so dialysis can stop.

  What are the burdens (harm)?

  Dialysis can cause problems. It’s time consuming and can be quite inconvenient for some people, especially if there are long distances to travel to receive dialysis. Dialysis also cannot completely replace normal kidney function, so many people with kidney failure on dialysis will still feel sick and tired. People on dialysis generally need to be very careful about their diet and control their fluid intake. Infection and discomfort can occur at the site of tube insertion. In older people, especially those with other serious illness, dialysis may not even help them to live longer, or may cause earlier death from complications.

  What if I do not want dialysis?

  If your kidneys are no longer working and you do not get dialysis, you will die naturally. If this is your choice, you will still get other medical care you need. Other treatments can keep you comfortable, manage pain, and control symptoms so you can live as well and as long as is possible for your health status.

  How do I decide what is best for me?

  Talk with your doctor and your loved ones about your medical and personal goals and values.

• Palliative Care

  Palliative care is specialized medical care for people with serious illness that is focused on providing relief from symptoms. The goal is to improve your quality of life. It is appropriate at any age and at any stage of an illness, and it can be provided along with curative treatment.

• Hospice Care

  Hospice care focuses on the quality of life rather than its length. It provides humane and compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible. Hospice care focuses on managing symptoms so that a person’s last days may be spent with dignity and quality, surrounded by their loved ones. Hospice care is used when you can no longer be helped by curative treatment and are expected to live about 6 months or less.

  Click here to learn about Washington State Hospice and Palliative Care.

  Click here to learn about National Hospice and Palliative Care.

• Dementia

  How much medical care would you want if you have Alzheimer’s disease or another type of dementia? We recommend visiting dementia-directive.org to learn more and to access a free advance directive for dementia.