Home Care & Hospice

Life support maintains vital functions

Life support replaces or supports a failing function of the body. If you have a curable or treatable condition, doctors can use life support temporarily until the illness or disease stabilizes and the body resumes its normal functions. In other situations, the body may never regain the ability to function without life support.
 
When considering your preferences for life support, gather the facts you need to make informed decisions. Think about the benefits and burdens the treatment may offer you and your loved ones. Make sure to document your decisions in advance directives.

Potential benefits of life support
  • Relieves suffering
  • Restores functioning
  • Enhances quality of life
Potential adverse effects of life support
  • Causes pain or marked difference in mental abilities
  • Prolongs dying process without offering benefit
  • Adds to perception of 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 life support would be offered and how it would benefit your care.

Commonly used life-support measures

Artificial nutrition and hydration

Tube feeding supplements or replaces normal eating and drinking. It delivers a chemically balanced mix of nutrients and fluids through a tube placed directly in the stomach, 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. The treatment helps patients enjoy a quality of life that is important to them.
 
Long-term use of tube feeding may be given to people with irreversible and end-stage conditions. The treatment may not reverse the course of the disease itself or improve quality of life.
 
Some healthcare facilities and doctors may not agree to stop or withdraw a feeding tube after it’s placed. That’s why it’s important to talk with your loved ones and doctor about life support. Clearly state your wishes about artificial nutrition and hydration in your advance directives.

Cardiopulmonary resuscitation

If your heart and/or breathing stops, you may receive cardiopulmonary resuscitation, or CPR. This group of treatments can restart the heart and breathing. CPR can mean only 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 also can 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. However, 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 to recover and leave 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, written by a doctor, directs emergency workers not to start CPR.

Mechanical ventilation

Ventilators, or respirators, can support or replace lung function. A machine forces air into the lungs. The ventilator is attached to a tube inserted through the nose or mouth and into the windpipe (or trachea). Mechanical ventilation can assist a person through a short-term problem. It also is used for prolonged periods when irreversible respiratory failure exists due to injuries to the upper spinal cord or a progressive neurological disease.
 
Some people on long-term ventilation can 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 another 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 doctor 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

Make sure you understand the difference between not starting treatment and stopping treatment. No legal or ethical difference exists between withholding and withdrawing a medical treatment when following a patient’s wishes. This is particularly important to know in a clinical setting, where a patient may forgo potentially beneficial treatment out of fear that it could not be stopped.
 
It is legally and ethically appropriate to discontinue medical treatments that no longer are beneficial. Remember, it’s the underlying disease, not the act of withdrawing treatment, that causes death.

We can help

Learn more about end-of-life care or contact Goshen Hospice, (574) 364-2700. .

Download your copy of “Approaching the End of Life” Guide