End-of-Life Care Decisions

Many decisions have to be made at the end of life. Some decisions concern the type of medical care and the extent of that care that you would like to receive. Planning ahead and discussing your desires is important because some day, you may be unable to make decisions if you become incapacitated in some way.

Here are some commonly asked questions about end-of-life care decisions:

Question: Some people choose not to receive certain types of treatment because they don't wish to prolong the dying process. What are those procedures?

• Cardiopulmonary resuscitation (CPR):
  If a person’s heart stops or if that person stops breathing and there is no indication of their preferences concerning CPR, health care professionals usually try to revive the person using CPR. In most cases when people have a terminal illness, this is not successful.
  You may ask your physician to write an Allow Natural Death or Do Not Resuscitate order even if you do not have an advance directive to request a do-not-resuscitate order.
• Artificial breathing: If your lungs stop working, your breathing can be continued using a machine called a ventilator. A ventilator is a device that pumps air into the lungs through a tube in the mouth or nose that goes down the throat.
• Artificial feeding: There are various methods to feed people who can no longer eat, including inserting a tube into the stomach, through a person’s nose or through the abdominal wall to bring food and fluids directly to the stomach or by giving liquid nutrients through a catheter in the vein.

Question: What about making decisions about feeding tubes and IVs?

Answer: Only an agent you have appointed under a health care power of attorney or your court-appointed guardian can make decisions to withdraw the artificial administration of food and fluids given through tubes and IVs. These statutory surrogates are allowed to consent to authorizing artificial food and fluid but may not authorize/consent to discontinuing them.

Question: What is palliative care?

Answer: Palliative care is treatment that focuses on relieving or reducing symptoms of a disease, such as pain, but does not cure the disease. Keeping the patient comfortable by treating symptoms and by using analgesics (painkilling medications) to relieve pain is an important aspect of palliative care. Your doctor can work with you to make a plan to manage your symptoms, so that you get relief from the problems associated with those symptoms. Palliative care will be provided regardless of whether you are receiving care to attempt to cure your disease and regardless of whether you have refused CPR or any other treatment.

Question: What is hospice care?

Answer: Hospice care is a type of care provided to a terminally ill patient. Hospice care focuses on enhancing the dying person’s quality of life rather than trying to cure the terminal illness. Hospice care is usually provided in the home, but also can be provided in a hospital or nursing home.

Question: What can I do to make sure my wishes regarding my health care are known and followed?

Answer: It is helpful to have advance directives, such as living will (a document that describes the treatment you would receive at the end of life) and a durable health care power of attorney for health care (a document that states identifies the person you have chosen to make medical decisions for you if you are unable to make them for yourself). These documents allow your loved ones and your health care providers to know your wishes and follow them. You should share these documents with your loved ones and your health care providers. Advance directives given to Banner will be placed in your medical record.

Question: What is a health care proxy?

Answer: A proxy is someone you choose (included in your durable health care power of attorney for health care document) or someone who is chosen for you (when you have not given previous instructions) to “stand in” for you to make medical decisions if you become unable to make decisions for yourself. This person should understand your wishes and, therefore, should be chosen by you before you can no longer make decisions.