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Understanding Life Support Measures

Life support replaces or supports a failing bodily function. When patients have curable or treatable conditions, life support is used temporarily until the illness or disease can be stabilized and the body can resume normal functioning. At times, the body never regains the ability to function without life support.

When making decisions about specific forms of life support, gather the facts you need to make informed decisions. In particular, understand the benefit as well as the burden the treatment will offer you or your loved one. A treatment may be beneficial if it relieves suffering, restores functioning, or enhances the quality of life. The same treatment can be considered burdensome if it causes pain, prolongs the dying process without offering benefit, or adds to the perception of a diminished quality of life. A person's decision to forgo life support is deeply personal. When gathering information about specific treatments, understand why the treatment is being offered and how it will benefit your care.

Commonly used life support measures

Artificial nutrition and hydration: Artificial nutrition and hydration (or tube feeding) supplements or replaces ordinary eating and drinking by giving a chemically balanced mix of nutrients and fluids through a tube placed directly into the stomach, the upper intestine, or a vein. Artificial nutrition and hydration can save lives when used until the body heals. Long-term artificial nutrition and hydration may be given to people with serious intestinal disorders that impair their ability to digest food, thereby helping them to enjoy a quality of life that is important to them. Long-term use of tube feeding frequently is given to people with irreversible and end-stage conditions. Often, the treatment will not reverse the course of the disease itself or improve the quality of life. Some health care facilities and physicians may not agree with stopping or withdrawing tube feeding. Therefore, explore this issue with your loved ones and physician and clearly state your wishes about artificial nutrition and hydration in your advance directive.

Cardiopulmonary resuscitation: Cardiopulmonary resuscitation (CPR) is a group of treatments used when someone's heart and/or breathing stops. CPR is used in an attempt to restart the heart and breathing. Electric shock and drugs also are used frequently to stimulate the heart. When used quickly in response to a sudden event like a heart attack or drowning, CPR can be life saving. But the success rate is extremely low for people who are at the end of a terminal disease process. Critically ill patients who receive CPR have a small chance of recovering and leaving the hospital. If you do not wish to receive CPR under certain circumstances, and you are in the hospital, your doctor must write a separate do-not-resuscitate (DNR) order in your medical record. If you are at home, some states including Ohio allow for a non-hospital or portable DNR order. This order is written by a physician and directs emergency workers not to start CPR.

Mechanical ventilation: Mechanical ventilation is used to support or replace the function of the lungs. A machine called a ventilator (or respirator) forces air into the lungs. The ventilator is attached to a tube inserted in the nose or mouth and down into the windpipe (or trachea). Mechanical ventilation often is used to assist a person through a short-term problem or for prolonged periods in which irreversible respiratory failure exists due to injuries to the upper spinal cord or a progressive neurological disease. Some people on long-term mechanical ventilation are able to live a quality of life that is important to them. For a dying patient, however, mechanical ventilation often merely prolongs the dying process until some other body system fails. It may supply oxygen, but it cannot improve the underlying condition. When discussing end-of-life wishes, make clear to loved ones and your physician whether you would want mechanical ventilation if you would never regain the ability to breathe on your own or return to a quality of life acceptable to you.

Kidney dialysis: Kidney dialysis is a life-support treatment that uses a special machine to filter harmful wastes, salt and excess fluid from your blood. This restores the blood to a normal, healthy balance. Dialysis replaces many of the kidneys’ important functions for people whose kidneys have stopped working properly. Dialysis is not a cure for kidney failure. If your kidneys do not work and you stop dialysis, your kidneys will continue to fail. You cannot live without at least one functioning kidney, unless you get a kidney transplant. For many people, the benefits of dialysis and the quality of life they experience as a result, outweigh the burdens of dialysis. But for some people, the opposite is true – the burdens of dialysis outweigh the benefits, especially if they have a terminal condition in addition to kidney failure. When discussing end-of-life issues, make clear to your loved ones and your physician whether you would want kidney dialysis, especially if it would not provide you with a quality of life acceptable to you or if it would only prolonging your dying.

Stopping and starting treatment:

The distinction often is made between not starting treatment and stopping treatment. However, no legal or ethical difference exists between withholding and withdrawing a medical treatment in accord with a patient's wishes. If such a distinction existed in the clinical setting, a patient might forgo treatment that could be beneficial out of fear that once started it could not be stopped. It is legally and ethically appropriate to discontinue medical treatments that no longer are beneficial. It is the underlying disease--not the act of withdrawing treatment--that causes death.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/22/2013...#12362