The primary goal of medical care has always been the preservation of life and health. However, every day decisions must be made about whether or not to withhold or withdraw life-sustaining measures. These decisions are made after careful consideration of the wishes of the patients and their relatives or family members. Withhold or Withdrawing Life-Sustaining Measures
Life-sustaining treatment is any medical intervention, technology, procedure, or medication that forestalls the moment of death, whether or not the treatment affects the underlying life-threatening diseases or biological processes. Examples include mechanical ventilation, dialysis, cardiopulmonary resuscitation (CPR), antibiotics, transfusions, nutrition, and hydration. Discussions about forgoing life-sustaining treatment will often be raised when death is the predictable or unavoidable outcome of the patient’s underlying medical condition. However, a patient need not be terminally ill or imminently dying for these discussions to be held.
Thanks to recent breakthroughs in medical science and technology, doctors now have available a variety of machines, devices and treatments to keep people alive when an important body system stops working properly. How to Make an End-of-Life Decision
Who Can Make Life Support Decisions?
For patients at the end of life, the potential benefits of medical treatment must be weighed against its potential to be burdensome, which might include pain, suffering, compromise of dignity, and loss of independence. In most situations, assessment of the potential benefits and burdens of treatment is based on various levels of probablity. The patients may need to make decisions about potential treatments if they are seriously ill or facing the end of life. When a patient has the capacity to make decisions for themselves, the treating medical team must respect the patient’s wishes. Doctors and medical staff have a duty to respect the patient’s right to refuse unwanted treatment and health care. However, Many of these patients also lack capacity for decision-making and rely on those closest to them or legal documents to support them and make decisions on their behalf
How to Make the Decision
Before making decision, you or someone you loved should evaluate the final goal and wishes of the patients. By gathering all the information you can about the types of life-sustaining measures the patient requires, you will be aware of the benefits and risks of each one. You can review the patient’s Advanced Healthcare Directive, Living Will, or Preferred Intensity of Care form if they are in a nursing home.
When the patient is unable to decide, then the decision to withdraw medical treatment is ultimately a medical decision made in the best interests of the patient. Doctors need to exercise caution not to transpose their beliefs, values and priorities on to the patient, but rather make a concerted effort to ascertain those of the patient. Determining what will be in the patient’s best interests requires careful consideration of medical and ethical factors. When determining what course of action is in the patient’s best interests, the health care team should conduct a formal review of the patient’s condition and likely prognosis together with an understanding of their support network, if appropriate. Discussion with family members is particularly important when the patient does not have the capacity to make or communicate decisions, as the family is likely to be aware of previously expressed views the patient may have held regarding end-of-life wishes, or to have an intimate knowledge and understanding of the patient’s wants, values and beliefs
After the Decision Is Made
It is not easy to make decision whether to withhold or withdraw life support for yourself or for someone you love. It is necessary to get some emotional support during and especially after making the decision. How you choose to complete your Health Care Directive and what measures you choose to take are up to you. Talk to your doctor and don’t be afraid to ask questions if you find the terminology confusing or you simply don’t understand. Ultimately understanding your Health Care Directive and the medical terminology associated with it will enable you to communicate your wishes to those providing your health care and increase the likelihood that your wishes will be honored.