End-of-Life Decisions

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End-of-Life Decisions: What Is It?

When it comes to end of life, research suggests many people have specific ideas for how they would like to spend their last days. Surveys also indicate the majority of people do not want their family to feel burdened by tough decisions regarding their end-of-life care. What’s more, many agree that they should ask loved ones about their end-of-life wishes.

And yet, hardly anyone is talking about end-of-life decisions with their family and loved ones.

Watch End-of-Life Decisions: Why Aren't We Talking?

Talking to family members about end-of-life decisions early, before a medical crisis arises, helps safeguard that wishes for end-of-life care are known and honored. Plus, knowing final days are spent as desired can bring comfort and peace of mind to both the patient and family members.

Many types of end-of-life choices

There are many decisions to be made near end of life. Some end-of-life decisions involve medical treatment and the extent of medical intervention; some concern quality of life and who will make decisions on the patient’s behalf if he or she is unable to do so.

While there is no way to plan for every end-of-life eventuality, talking about preferences for end-of-life care can help prepare family members for most situations. For example, understanding if someone does not want life-prolonging treatments if he or she has no chance of recovery can help family members in the event of trauma, prolonged unconsciousness or a diagnosis of dementia.

At the same time, if family members know that their loved one does want life-prolonging treatments no matter what, then they will know to pursue or continue life-sustaining care.

End-of-life decisions to think about

Some of the end-of-life decisions families may face, and important questions for loved ones to ask, include:

  • Do you want to live as long as possible, no matter what?
  • Is quality of life more important than quantity of life?
  • How important is it to be physically independent and to stay in your own home?
  • Do you wish your final days to be spent at home, in a hospice facility or in a hospital?
  • Who would you like to make decisions for you, if you are unable to make them yourself?
  • When would it be okay to shift from a focus on curative care to a focus on comfort care alone?
  • If you are seriously ill with little or no hope for recovery and your heart stops beating, do you want to be resuscitated? Would you want to have a ventilator breathe for you?
  • If you are seriously ill with little or no hope for recovery and are unable to eat or drink, do you want IV hydration? Do you want a feeding tube to provide you with the nutrition you need to continue living?
  • If dying in your own home is a priority, would it remain your wish even if it caused emotional or physical stress for your family members?

When it comes to end of life, research suggests many people have specific ideas for how they would like to spend their last days.

“Keys to Quality Care.” National Hospice and Palliative Care Organization.
http://www.nhpco.org/about-hospice-and-palliative-care/keys-quality-care

“Final Chapter: Californians’ Attitudes and Experiences With Death and Dying.” California Healthcare Foundation, 2012.
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/F/PDF%20FinalChapterDeathDying.pdf

Surveys also indicate the majority of people do not want their family to feel burdened by tough decisions regarding their end-of-life care.

“Final Chapter: Californians’ Attitudes and Experiences With Death and Dying.” California Healthcare Foundation, 2012.
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/F/PDF%20FinalChapterDeathDying.pdf

What’s more, many agree that they should ask loved ones about their end-of-life wishes.

The Conversation Project Surveys,” conducted by Kelton, August and September 2013.
http://theconversationproject.org/wp-content/uploads/2013/09/TCP-Survey-Release_FINAL-9-18-13.pdf

And yet, hardly anyone is talking about end-of-life decisions with their family and loved ones.

“Final Chapter: Californians’ Attitudes and Experiences With Death and Dying.” California Healthcare Foundation, 2012.
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/F/PDF%20FinalChapterDeathDying.pdf

“The Conversation Project Surveys,” conducted by Kelton, August and September 2013.
http://theconversationproject.org/wp-content/uploads/2013/09/TCP-Survey-Release_FINAL-9-18-13.pdf

“Views on End-of-Life Medical Treatment.” Pew Research Center, November 21, 2013
http://www.pewforum.org/2013/11/21/views-on-end-of-life-medical-treatments/

Plus, knowing final days are spent as desired can bring comfort and peace of mind to both the patient and family members.

“The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.” K. Detering, et al. British Medical Journal. March 24, 2010, vol 340:c1345.
http://www.bmj.com/content/340/bmj.c1345

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