Dear Doc | Making life-changing decisions
Q Dear Doc,
A I am sorry to hear about your illness. Though you did not state the nature of it, I have written my answer assuming it is an advanced or terminal illness.
Unfortunately, it is true, some advanced illnesses can be slowed down but not cured. It is also true that they can be treated in more than one way, and most times, treatments are intended to relieve symptoms rather than extend life very much.
This means that people with life-threatening illnesses often have tough choices to make in deciding which treatments are right for them.
The first and most important thing for you to do is to decide what matters most to you, and what you want out of your treatment. This is very important, because two people could have the exact medical problem, but choose different treatments based on what they value most. One person may select a treatment option that makes them feel tired and weak, because it might extend their life by a few months, while another may prefer to skip the treatment and instead have more energy, even if this means that his life might be cut a little short.
Doctors and nurses are experts in medicine, but you are the expert in what matters most to you.
Next will be to select a family member or friend to take part in your care. Ensure that your doctors meet this person, and that they are both made aware of your wishes.
You should decide how aggressive you would want your treatment to be. Meaning, do you want your doctors to do everything possible to keep you alive? Or would you prefer to skip aggressive care and have the doctors focus on making you as comfortable as possible?
It is best to decide on this and let your family member or friend, as well as doctors, know this before you get too sick, forcing you and your loved ones to have to make big decisions under pressure.
Examples of this includes breathing tubes, feeding tubes, and cardiac resuscitation. These treatments might cause discomfort and yet not prolong life in a meaningful way.
Ask yourself ‘what if’ questions to help you decide:
- What if I stop breathing? Do I want to be put on a breathing machine?
- What if my heart stops? Do I want the doctors to try to shock my heart back into action?
- What if I can’t eat? Do I want a feeding tube put in?
‘What if’ questions are hard to ask. But if you think about them ahead of time and let your doctor and your family know what you would want in these situations, it makes it much more likely that you will be able to choose your own path. It also makes things easier for your family.
If you would like to make your wishes known, there are legal documents that can help you. These documents are called ‘advance directives’.
There are many kinds of advance directives, but the three most useful kinds are called:
HEALTHCARE PROXY/ POWER OF ATTORNEY
This document allows you to choose someone to make medical decisions for you if you become unable to speak for yourself, and makes it clear, to your doctors and to your family members, who you want to speak for you. When you choose a healthcare proxy, it is important to talk to the person you choose about the things that you want; that way, they will know how to make decisions for you.
A living will allows you to choose now, the type of care you want if you become unable to speak for yourself. For instance, a living will allows you to document whether you want to be fed through a tube if you become unable to eat.
DO NOT RESUSCITATE (DNR)/DO NOT INTUBATE ORDER (DNI)
If you decide you do not want your heart restarted if it stops, and you do not want a breathing tube put in if you stop breathing, you can ask for a DNR/DNI. This is a form that must be signed by a doctor. It tells all your healthcare providers that you have decided you do not want these treatments.
Regarding comfort and not suffering, there is a kind of palliative care called hospice care.
Hospice care is only for people who are not expected to live longer than six months. Deciding to use hospice care, can make the last months of life much easier. People who choose hospice care often decide that they want to die at home, and they can get medicines and helpers who can make the last stages of illness as comfortable as possible.
I hope this information was helpful to you and the decisions you are now faced with.