Understanding Medical Treatment Options
The advance care planning process can be very useful in helping individuals to understand and clarify their wishes and values as they relate to future medical treatment choices. Considerations include:
- When to start treatment
- When to stop, or not start, treatment
- What are the goals of treatment
- How and when to use comfort measures
Following are a list of medical treatments that are considered lifesaving or life sustaining. Decisions to accept or forego each of these treatments must be considered in relation to the individual's health and personal values and wishes. For example, there is no question that antibiotics would be given to a healthy child who has developed an infection. However, while one person may choose at end of life to forego treatment and “let nature take its course,” another individual may find it unacceptable to withhold treatment.
Cardiopulmonary Resuscitation (CPR)
CPR provides breathing and chest compressions when a person’s heart or breathing has stopped and provides blood flow to the heart and brain to “buy time” until the heart or the ability to breath begin to function normally.
While television shows frequently portray CPR as being successful, the truth is that less than half of all people whose hearts stop are revived and half of these die in the next two days. One in five people, or 20 percent, will leave the hospital, usually to a nursing home. For those with advanced cancer for whom CPR is attempted, survival and leaving the hospital is rare. Generally, those who were in good health and living independently before receiving CPR recover most fully.
Intubation and Ventilation
When someone cannot breathe on their own, a tube is placed into their trachea or windpipe, either through the mouth or an opening created in the neck and the tube is connected to a machine called a ventilator.
For someone who has been in an accident or has a sudden illness, intubation and ventilation can be lifesaving; however, individuals with advanced lung disease or other debilitating conditions can be very difficult to wean from the ventilator once started.
It is very important to consider what you would like medical personnel to do in the event that you were to stop breathing suddenly or your heart were to stop. You might be in a medical facility or paramedics could be called. Would you want CPR and/or a ventilator? Would you prefer to not be resuscitated? Your answer will probably depend on your health at the time. Medical staff must do everything for you in this situation – possibly including CPR, defibrillator, rescue IV medications, and ventilator, unless you make your wishes known otherwise.
IV Hydration and Nutritional Support
IV hydration and nutritional support may be given when an individual cannot eat or drink enough to sustain life. IV hydration refers to fluids given through a tube inserted into a blood vessel. Nutritional support may be given through a vein, a tube passed through the nose into the stomach or intestine, or a tube surgically inserted through the abdominal wall into the stomach or intestines.
Whether to start, stop, or continue IV hydration and nutritional support is perhaps the most difficult decision to be made in relation to healthcare. As death approaches, the body’s need for fluids and nutrients wanes, as well as the body’s ability to flush fluids and digest food. Some people believe that not giving fluids and nutrition allows the natural process of dying to occur. Others may consider foregoing nutrition or hydration as inhumane. It is important for everyone to consider carefully when they believe such support should be given. Identify goals for treatment and think about when or if it should be discontinued. Make these wishes known to family members, healthcare advocates, and medical care providers.
Kidney or Renal Dialysis
Kidneys play an important role in the body, filtering the blood to get rid of wastes and extra water by making urine. When the kidneys are not working properly, wastes can build up in the body and cause illness and even death if not treated. When the kidneys stop working, dialysis is performed to filter the blood through a machine to get rid of waste products.
For some, dialysis is required for a short time until the kidneys begin functioning on their own. For individuals with end-stage renal failure, dialysis is usually required three days a week for the rest of their lives, or until they receive a working kidney through a transplant, if eligible. In addition to dialysis, individuals with end- stage renal disease must follow a very strict diet and limit fluid intake.
Antibiotics
Antibiotics are drugs that help the body fight infections caused by bacteria. The term antibiotic is sometimes used to describe drugs that fight other organisms that cause infections.
Conditions such as pneumonia or urinary tract infection may be easily treated with antibiotics, although organisms that have become resistant to antibiotics are becoming more common. The decision to treat these conditions in an individual who is terminally ill or has a condition from which they are unlikely to recover can be very difficult, especially near the end of life.
Taking Time to Consider End-of-Life Treatment Options
Making decisions about future medical care requires much discussion and reflection and can be a very emotional process. Everyone must make decisions that are right for them, but should do so with input from respected family members and friends, spiritual leaders, and/or healthcare providers. It is also an ongoing process. What is right for a person now may not be right six months or 10 years from now. Some questions to ask include:
- What experiences have you had with a loved one or close friend who faced decisions about a life sustaining treatment and what did you learn from that?
- When would I want life-sustaining treatment and under what circumstances would I want it stopped?
- What do the terms “a good life” or “living well” mean to me at this point in my life?