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Understand health care choices
When a health care decision needs to be made, it is important to gather information to make an informed decision. Many treatments will have both positive and negative sides to consider. They may cause pain, or require rehabilitation, or require hospitalization. When making a health care decision, it is important to consider the benefits and burdens of the treatment options by talking with your doctor about the following:
- Will the treatment make a difference?
- Will I be cured, or recover abilities, or be relieved of pain or other symptoms?
- How will I be after the treatment? How will it affect my life?
- Is the treatment difficult to handle?
- How long is the recovery period and what will I need to do?
It is important to learn enough about the treatments to decide if the benefit is worth the burden. Sometimes a treatment will eliminate a problem, such as antibiotics to get rid of an infection. Sometimes a treatment is used to relieve pain and suffering, or to improve function. Some treatments will prolong life and other treatments prolong the dying process. It is difficult to predict medical situations to make health care decisions in advance. Also, advances in treatment are developing all the time and new choices may be available in the future. So, the most important thing is to talk about your personal beliefs and values, related to what you know about your medical conditions, to help your health care agent know what is important to you.
For some treatments, when the outcome is unpredictable, you can agree to a short-term trial. For
example, short-term use of a ventilator may help with breathing to allow the body to heal and stabilize. A trial period can be discussed with your doctor. At the end of the trial period, you can choose to continue or stop the treatment.
You may want to give your health care agent special instructions on some possible medical treatments about which you have strong opinions. Some examples of these treatments are provided for your consideration.
Antibiotic therapy
Artificial hydration and nutrition
(food and water provided by feeding tube)
Artificial respiration or mechanical ventilator
Cardiopulmonary resuscitation (CPR)
Comfort Care
Elective Procedures
Dialysis
Pain Management
Antibiotic therapy
Antibiotic therapy uses pills, injections or intravenous methods to provide drugs to combat infections. Many infections like pneumonia and urinary tract infections can be cured with antibiotics. At the last phase of life, some people will choose not to use antibiotics for such things as pneumonia to allow a peaceful death from the disease.
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Artificial hydration and nutrition
Artificial hydration and nutrition uses tubes to provide nutrition (food) and hydration (fluid) to replace or add to ordinary eating and drinking. The tube is placed in the nose to go down your throat to your stomach, or inserted by needle into a vein, or by surgery into the stomach or upper intestine. Artificial hydration and nutrition can save lives when used while the body is healing. Long-term use may be important for people with serious intestinal problems that make eating impossible. Artificial hydration and nutrition are also considered when people have irreversible conditions or are near death. Medical personnel will insert artificial hydration and nutrition tubes unless you or your agent make the decision not to use this treatment. Often, in these cases, the treatment will not reverse the course of the disease or improve the quality of life. In fact, the treatment sometimes prolongs the dying process. When a person is dying, the body naturally adjusts to the absence of food and fluid and the person does not starve to death.
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Artificial respiration or mechanical ventilator
A mechanical ventilator is used to support or replace the function of the lungs in breathing. A machine is attached to a tube that is inserted through the nose or mouth into the windpipe. This machine forces air into the lungs. Ventilators are used both for short-term treatment to help a person recover from illness, and long-term for people with irreversible breathing problems. For a person who is dying, use of a ventilator often prolongs the dying process, keeping the person alive until another body system fails. Ventilation provides oxygen but it does not improve the cause of the breathing problem.
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Cardiopulmonary resuscitation (CPR)
Cardio pulmonary resuscitation means the use of treatments to restart the heart and lungs. This may include pressing hard on your chest to keep your blood pumping, mouth to mouth breathing, electrical shocks to jump start your heart, and/or drugs injected into your veins to stimulate the heart. When used quickly, after a heart attack or drowning, CPR can save lives. However, for older adults with chronic health problems, very few will recover after CPR. Other complications can also occur for older adults who do survive: ribs may be broken, internal organs may be damaged, and if the process took too long, rain damage may result. Medical personnel will attempt CPR unless you have a Do Not Resuscitate Order.
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Comfort Care
Sometimes in the last phase of life, the goal for treatment changes from cure to comfort care. This means that treatment will focus on compassionate care and the management of symptoms. Comfort care does not mean "no care." Comfort care includes such things as pain management, nursing care to maintain cleanliness and prevent skin breakdown, and oxygen to support breathing but not a mechanical ventilator. Comfort care also includes emotional and spiritual support for the person and those close to them.
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Elective Procedures
Many surgeries and other treatments are considered elective. This means that they are not necessary to sustain your life but may add comfort, improve your function, or prevent a possible problem in the future. Elective procedures include such things as colonoscopy, joint replacements of hips or knees, dental procedures, and some skin cancer removals.
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Dialysis
The body's kidneys may fail slowly from a long illness, or very quickly from illness, making it impossible for the kidneys to adequately clean the blood. Dialysis is necessary in these cases to remove impurities from the blood because the kidneys can no longer do this. Dialysis may be useful for a short period of time while the body heals, or it may become a necessary treatment for the rest of your life. Most people who are on dialysis for long-term treatment and who choose to stop the dialysis will die naturally and peacefully within about a week.
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Pain Management
Pain management has become very effective. Most pain can be controlled. Some of the strongest pain medications can cause drowsiness so some people will decide to live with some pain to be more alert. Pain medications do not shorten a person's life.
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Decisions will include both starting and stopping treatments, as well as short-term treatment trials. All are important decisions and should be made according to your wishes. To help make the best decisions, it is important to discuss your medical condition with your doctor and to ask questions about the choices you or your agent may need to make. It is legally and ethically appropriate to stop a treatment that is no longer effective and is not helping the person. If death is the result, it is the underlying disease, not the withdrawal of treatment that causes the death.
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Advance Directives
