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End-of-Life Healthcare Decisions

CPR: Doing CPR on an elderly, debilitated patient with a terminal illness may do more harm than good. Risks include broken ribs, collapsed lungs, brain damage, and permanent need for a ventilator. The chance that it would return the patient to his or her former quality of life is practically nil. If you decide you don’t want CPR to be conducted on your loved one, you’ll need to ask the person’s physician to put a DNR order in the chart.

Antibiotics, Hospitalization, Ventilator: It’s probably best to make decisions about these issues at the time of need rather than in advance. The decisions have to take into account the patient’s general condition. Is the patient alert and responsive? Is he or she in pain? What is the person’s quality of life? Is the patient likely to recover from whatever is causing the need for the antibiotic, hospitalization or ventilator? For example if a frail patient has pneumonia, you can try antibiotics and a ventilator if needed, but if the patient continues to get worse, you can then withdraw the medication and ventilator and allow the person to die in peace.

Hospice: In order to receive hospice services you have to agree to forego aggressive treatment for the terminal diagnosis. This means that the patient would not be put on a ventilator, for example. Or if the patient is hospitalized, it would only be for comfort care.

Symptoms that the Patient Qualifies for Hospice Care: It may be time to consider using a hospice service if the patient is showing any of the following: 1) Two or more episodes of pneumonia or other serious infections during the past 6-months, 2) Difficulty eating and swallowing, even with feeding help, that results in weight loss of 10% or more over the preceding 6 months and 3) One or more skin pressure ulcers that are not healing.

The “Real” Issue: All of these decisions are very difficult, but the real issue is to stop focusing on the person’s approaching death and start figuring out how to do everything you can to help the patient have the highest possible quality of life in the time that’s left. This dynamic shift in thinking – from death to life – will benefit both the patient and the caregiver.


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