The use of technology in health care has led to wonderful advances in human health. As a doctor, Ive relied on many of these tools to save lives and improve patient lives. But what may be miraculous for one patient may be totally inappropriate for another. So, how do health care professionals help patients and their families make choices that are best for them, especially at the end of life?
Patients and family members often struggle with decisions about care at the end of life, wanting to do something but unsure of what exactly that something should be.
The stress and anxiety of the situation can mean rash decisions that may not be in the best interests of the patient.
Cardio Pulmonary Resuscitation (CPR), for example, is often depicted as a dramatic and life-saving event on television and it can be in an emergency such as a heart attack. But for a patient near the end of life, CPR offers no improvement in their condition and may in fact cause harm.
If the heart is able to be restarted (usually this is less than 5 patients in 100), the patient usually has to be on a ventilator – and about 40% suffer from serious brain damage due to lack of oxygen. At the end of the day, the underlying condition that has brought them to the end of their life is still there. And yet, for family members under stress, CPR may be perceived a doing something to save a loved one.
So, whats the best way to make these important decisions for you or someone you love?
First, make sure you understand the health care teams recommendation to start or stop treatment. Dont be afraid to ask questions and keep asking until you understand. Patient decision tools and glossaries are also available to help patients and their loved ones better understand treatment options and any side effects.
Remember that any decisions you make can be changed you can try most treatments for a time, or decide to stop treatment if its not working. Pain and symptom relief should always be provided and is not something you have to give up if you wish to try treatments to extend your life.
Of course, the best way to avoid the stress and anxiety of making decisions during a traumatic time is to make an advance care plan. Your plan is about what you value not what technology you wish as it is too difficult for anyone to predict the future. Your plan should name a Substitute Decision Maker someone who can speak for you when you cannot speak for yourself. This should be someone who you feel knows your values and goals well.
Health care professionals have a goal to do no harm to do that, we need to communicate end-of-life care options to our patients and their families but we also have a duty to understand patient values and goals in order to know what options to offer. Help us help you get the end-of-life care that you prefer and deserve.
Dr. Romayne Gallagher is the Head of Palliative Residential Care at the University of British Columbia and a member of the Advance Care Planning Task Group.