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. 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 decline 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) adds to 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 weaken their ability to digest food, and 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 an out-of-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 help a person through a short-term problem, or for prolonged periods in which irreversible respiratory (breathing) failure exists because of 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 extends 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 prolong your dying.
Stopping and Starting Treatment
The distinction often is made between two issues: not starting treatment, and stopping treatment. However, there is no legal or ethical difference between withholding and withdrawing a medical treatment in agreement with a patient's wishes. If there were such a distinction in the clinical setting, a patient might decline treatment that could be helpful out of fear that once the treatment 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.
Few people make good decisions when they feel pressured and rushed. Choices such as these require time for discussion and for asking questions. Ideally, it is helpful to think about these situations before they occur and to share your views and feelings with your doctor and your family.
Here is a guide to help you to have the conversation with your doctor: How to Talk to Your Doctor.