Important Decisions to Be Made in the Dying Process
Many important decisions need to be made when a person is diagnosed with
a terminal illness.
Right to refuse treatment.
The patient and family have the right to refuse treatment, and in most
cases, health care providers will agree and follow their wishes. Occasionally,
especially when the family makes decisions without a health care proxy
or advanced directive, or when there are disagreements among family members,
the health care team may ask for more discussion. Involving experts in
medical ethics and senior physicians usually achieves a consensus that
will be in line with the patient's wishes.
Decision to die in the home versus hospital setting.
Many families want their loved ones to die at home in their natural and
most comfortable setting. Others do not feel they can emotionally handle
the death in their home. Include all family members in this important
decision. Not all decisions have to be made at once, and they can be reversed.
In some cases, families think they want to be at home and then find the
hospital to be more comfortable, whereas some families choose to be in
the hospital and then find that they and the patient are more comfortable
at home. Time and circumstances can help to make these decisions. Ask
as many questions as possible to get the information needed to make the
best decision for your family.
Advance directives, if age 18 or older.
Adults can prepare an advance directive. Advance directives are documents
that are used only if a person loses capacity to make decisions, or suffers
an injury or disease that renders him or her unable to communicate his
or her wishes. People younger than 18 may prepare an advance directive.
In most cases, however, parents or health care providers are not required
by law to honor it.
A living will covers health care decisions when you are terminally ill
or permanently unconscious.
Health care power of attorney or health care proxy.
Durable power of attorney for health care allows a person to name an agent
or proxy (substitute person) to make health care decisions if the time
comes when the patient is unable to do so.
Do not resuscitate (DNR) order.
A do not resuscitate order is a formal request by a person or a person's
family to not take extreme measures to save his or her life. A DNR order
is usually reserved for a person near death or with a terminal illness
who, even if resuscitated, would not have a high quality of life or a
long period before death would occur despite resuscitative efforts. DNR
orders can specify how much intervention is desired before death (for
example, no use of cardiac drugs, no oxygen, or no chest compressions).
These need to be discussed and written by a physician. A DNR is also needed for home.
An autopsy is an examination of the organs and/or tissues of the body after
death. An autopsy is often used to determine the cause of death, but it
may also be done to research the fatal disease for future diagnosis, treatment,
and prevention strategies, or to improve the quality of care in the hospital
or for medical teaching. The decision to have an autopsy is a personal
choice and should be decided upon when the family is ready. Often an autopsy
may help the family with closure. In a patient with a rare disease or
cancer, or with a condition that has a genetic cause, an autopsy can provide
important information for other family members. If genetic testing has
not already been done, or is not available at the time, DNA banking may
provide an option of testing in the future.
Organ donation, if possible.
Laws governing organ donation vary slightly from state to state. Your health
care provider will be able to inform you of these options.
Palliative care is care aimed at comfort vs. cure and treatment. Hospice
is a type of palliative care that provides services to improve the quality
of life for the family and patient, stressing peace, comfort, and dignity.