Understanding life support

Life support replaces or supports a failing bodily function. If a patient has a curable or treatable condition, life support is used temporarily until the illness or disease can be stabilized and the body resume normal functioning. In other situations, once on life support, the body may never regain the ability to function without life support.

When making decisions about life support, gather the facts you need to make informed decisions. In particular, be sure you consider the benefit as well as the burden the treatment may include for you and your loved ones.

A treatment may be beneficial if it

  • relieves suffering,
  • restores functioning or
  • enhances the quality of life.

The same treatment may be considered burdensome if it

  • causes pain or marked difference in mental abilities
  • prolongs the dying process without offering benefit or
  • adds to the perception of a diminished quality of life.

Choosing to forgo life support is a deeply personal decision. When you are gathering information about specific treatments, be sure you understand why the treatment would be offered and how it would benefit your care.

Commonly used life-support measures

 

Artificial nutrition and hydration (or tube feeding)

This supplements or replaces normal eating and drinking by giving a chemically balanced mix of nutrients and fluids through a tube placed directly in 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.

But 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 directives.

Cardiopulmonary resuscitation (CPR)

This 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. It may consist only of mouth-to-mouth breathing or it can include pressing on the chest to mimic the heart’s function and cause blood to circulate.

Electric shock and drugs are also used frequently to stimulate the heart. When used quickly in response to a sudden event like a heart attack or drowning, CPR can save a person’s life. But the success rate is extremely low for people who are at the end of terminal disease process. Critically ill patients who receive CPR have a small chance of recovering and leaving the hospital.

If you are in the hospital and do not wish to receive CPR under certain circumstances, your doctor must write a separate do-not-resuscitate (DNR) order on the chart. If you are anywhere outside of the hospital, Indiana allows for an out-of-hospital DNR order. This order is written by a physician and directs emergency workers not to start CPR.

Mechanical ventilation (lungs)

This 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 ventilation are able to enjoy themselves and live a quality of life that is important to them. For the dying patient, however, mechanical ventilation often merely prolongs the dying process until some other body function 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 not regain the ability to breathe on your own or return to a quality of life acceptable to you.

Additional issues

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 accordance 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.