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What Seriously Ill Patients Should Know

Below are some questions that seriously ill patients and their loved ones may have in regard to treatment:

What are life support systems?

People think of life support systems as machines that keep you alive, such as a ventilator that breathes for you when you cannot breathe on your own. In the truest sense, however, a life support can be something as simple as a tube that delivers nourishment or antibiotics to treat an infection.

Life support systems are used every day to help people during an illness and to return them to good health. Ventilators, for example, are used after surgery to support a patient's breathing until he or she wakes up enough to breathe on his or her own.

Unfortunately, during a serious illness, you or your family may need to make a decision about starting or continuing life support systems. There may come a time when the burdens of treatment, such as pain and suffering, may outweigh the potential benefits of continuing such treatment. In these situations, continuing treatment may simply prolong the process of dying.

When it is clear that there is no chance for recovery or survival despite all that is being done, many people would prefer not to be placed or kept on life support systems. Choices such as these require time for discussion and for asking questions. Few people make good decisions when they feel pressured and rushed. It is helpful to think about these possible situations before they occur and to share your views and feelings with your doctor and your family.

 

What does resuscitation mean?

Resuscitation is better known as CPR or cardiopulmonary resuscitation. This may include:

  • Manual chest compression or force applied over the breastbone to stimulate the heart
  • A tube placed in the windpipe so that oxygen can be sent to the lungs, including the possibility of being connected to a ventilator
  • Electric shock given to the heart and strong drugs administered in an effort to stimulate the heart and to restore blood pressure.

There are situations when this all-out effort may not be the best thing to do. For example, at the end of a terminal illness, the patient or family members may not want these "heroic measures" performed because the patient has no chance of recovery. Resuscitation could mean continued, needless suffering.

Your doctor may raise the question of a Do Not Resuscitate (DNR) status. You may want to ask your doctor about this. When possible, it is important that this decision be discussed with your family and close friends.

Download Do Not Resuscitate Orders and Comfort Care brochure.

What is the difference between resuscitation and general anesthesia?

Many patients are not aware of the difference between resuscitation and what an anesthesiologist does when administering general anesthesia.

During resuscitation as well as administration of general anesthesia:

  • The patient is generally unconscious
  • Intravenous (IV) lines are started
  • Medications may be necessary to increase a patient's blood pressure or to treat an abnormal heart rhythm
  • Meticulous attention to a patient's airway (the way a patient is helped to breathe effectively) is vital to the success of the anesthetic or the success of a resuscitation.
Is A Ventilator Necessary?

Ventilators are used during an operation for the convenience of the anesthesiologist. Ventilators free the anesthetists hands for purposes of giving medications, keeping operative records and giving fluids during surgery.

Ventilators are also used to administer anesthetic gases and can be used to optimize a patient's oxygen level while he or she is unconscious. In rare circumstances, a ventilator may be needed for an hour or two after an operation while a patient's body is eliminating anesthesia medications. Use of a ventilator is temporary and is not needed once the patient has fully recovered from the anesthesia.

We are here to help

As part of your healthcare team, nurses, social workers, chaplains and members of the Bioethics Department are available to you for support and guidance. We encourage you to take advantage of their assistance. Learn more about them:

Ethics consultation is a service provided to all patients and their families through the Bioethics Department. Upon request, the Ethics Consultation Service can provide ethical advice related to issues arising in the course of patient care. There is no charge for this service.

Ask your physician, nurse or other member of the healthcare team to communicate your request for an ethics consultation. You may also choose to call the Bioethics Department directly at 216.444.8720 during normal business hours. On evenings and weekends, you can ask the hospital operator (216.444.2200) to page the Ethics Consultation Service.

Nurses can assist you by answering questions or directing you to other members of the healthcare team. Furthermore, they can assist you in discussing treatment decisions with your doctor. They can also help you consider your choices or options and deal with your feelings and concerns.

Our chaplains can offer assistance with spiritual or personal problems and needs. They also can assist you or your family during times of crisis. If you face decisions about life support systems, the chaplains can offer you guidance. They will help you consider your options and help you deal with your feelings and beliefs.

Social workers also are available to you and your family. They can guide you through the difficult social and emotional questions that can arise during times of illness. Social workers can help with family stresses and coping with the results of a decision. Their counsel and information can provide you and your family with additional support to face these decisions together.