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Understanding End-of-life Care Decisions and their Related Issues

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vinay kumar singhEnd-of-life Care is a type of health care provided to those who are suffering from a terminal illness which has become advanced, progressive and incurable. It includes hospice care which is often given in conjunction with the palliative care. Advance directives that are concerned with patients’ wills and power of attorney outlining their choices during the last few months or weeks are useful documents that have a statutory basis in every state of the United States. Unfortunately, it has been observed that these documents more often than not are incomplete or are not detailed enough to address some key heath choices.

The most pragmatic solution to this problem involves an effective communication between the patient, family members and the clinicians involved. Important decisions related to palliative care, spiritual care, in-home care, CPR use, DNR orders, nursing, social services etc. are needed to be addressed at length among all the invested parties. Physicians play a pivotal role in this process as they must have knowledge about the state law, guidelines and end care policies to provide the best advice to the families and guide them when legal consultation or court order becomes necessary.

Apart from the physicians involved, nurses and social workers also prove to be useful in making decisions such as when to withhold or completely stop a particular treatment, changing severity of future treatments such as use of feeding tube or dialysis and patient whishes regarding the option of cardiopulmonary resuscitation as these care providers are in a close contact with the patient and his/her family.

Detailed medical information on the patient’s condition must form the base for any type of decisions that are made. Information on laboratory data, procedures followed for treatment till date and their effects on alleviating pain etc. must be put into perspective while making such decisions. It has been noted that most terminally ill people prefer to spend their last weeks or days at home and end-of-life care decisions related to in-home care services must be contingent on the patients’ medical history and wishes.

One critical area that requires clarity for medical care providers is that who is going to speak on the patient’s behalf when difficult decisions have to be made. Because of this reason, advance directive and power of attorney are imperative to be made in advance rather than waiting till the last few days.

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