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End-of-Life Care and Pain Control
Guidelines for Making End-of-Life Medical Decisions
Today's advances in medical technology can sustain the lives of patients in otherwise dire circumstances. Some people want every possible treatment medical science can offer; others do not. Competent adults have a legal right to refuse or have withdrawn any medical treatment. But what can you do if loved ones are unable to make their own medical decisions near the end of their lives? How can you make the right choices for them? The following may be helpful in making end-of-life decisions for family members.
Questions to Ask
- Did your loved one sign an Advance Directive (Living Will, Durable Power of Attorney for Health Care, etc.) in which the patient indicates an end-of-life request?
- What is the likelihood of recovery or improvement? What is the likelihood of death within six months, even if treatment is continued?
- What is the faith/religious background of the patient, and what would they want in light of that background?
- What are the attending physicians' ethical views regarding end-of-life medical decisions?
- What are the policies and procedures of the health care facility regarding end-of-life medical decisions?
- What are the financial constraints that may have an impact on this decision (e.g., limited HMO or Medicare/Medicaid coverage)?
- Will a decision to discontinue treatment cause death or allow a natural death?
- What is the available technology and will it benefit the patient? If the answer is yes, would the patient want this technology utilized? If the answer to either question is no, have you considered alternatives such as palliative care and hospice?
In any discussions with family members or medical professionals, it is essential that you define the terms used to ensure that all parties interpret the words in the same way.
Acute care: The goal is to cure the patient.
Palliative care: The goal is to make the patient comfortable and meet his or her physical, spiritual, and psychological needs.
Terminally ill: Although a patient may be diagnosed with a terminal condition, this term generally refers to cases where death is likely within six months.
Do Not Resuscitate (DNR) orders: DNR orders state that the patient (or another party) wants to allow nature to take its course. The DNR prevents any aggressive medical intervention should the patient stop breathing or suffer a cardiac arrest. However, DNR orders can be interpreted very narrowly. You need to define the term with the health care facility.
"Pulling the plug": This is a lay term used to include everything from turning off a respirator to withholding food and water. It is better to avoid this term and specifically state what treatment and procedures you do or do not want.
Physician-assisted suicide: A medical doctor provides patients with the means to kill themselves.
Euthanasia: The intentional killing of a patient by the direct intervention of a physician or another party, ostensibly for the good of the patient or others.
Quality of life: A subjective, non-medical assessment of the patient's satisfaction with his or her present circumstances.
Talk to your family about your end-of-life wishes before a medical crisis puts them in a position to make decisions when you are incapacitated. For more information on these discussions, contact:
The Center for Bioethics and Human Dignity
2065 Half Day Road
Bannockburn, IL 60015
To download a copy of Rhode Island’s “Will to Live” durable power of attorney form, click here.
The National Catholic Bioethics Center: http://www.ncbcenter.org