-by Melissa DelaCalzada

We’ve talked about when is the right time to have end-of-life conversations, but many people may not even know what health care decisions need to be made. Often times people find themselves in a situation where they are suddenly faced with making end-of-life care choices for a family member or close friend, without having had time to have these conversations. Should you find yourself in this position, The National Institutes of Health provides caregivers, patients and people a great resource on the topic.

If you do have time to prepare, here are some common end-of-life questions to consider and a few of the decisions you may be faced with making:

• When we say “do everything,” what does that mean? This means that if someone is dying, all measures that might keep vital organs working will be tried. For example, a doctor may use a ventilator to help with breathing or start dialysis for failing kidneys. Such life support can sometimes be a temporary measure that allows the body to heal itself before it can begin to work normally again. It is not intended to be used indefinitely. It’s important to be aware that “doing everything” does not include medical treatments intended to cure a medical condition, such as surgery or chemotherapy.
• What if someone needs help breathing or completely stops breathing and goes into respiratory arrest? In this situation, the family is usually faced with two choices. Sometimes doctors suggest using a ventilator that forces the lungs to work. Initially, this would involve intubation which is when a doctor puts a tube attached to the ventilator down the throat into the trachea or windpipe. Because this tube can be quite uncomfortable, people are often sedated prior to the procedure. Should the person need ventilator support for more than a few days, the doctor will probably suggest a tracheotomy. This involves a bedside surgery so that the tube can be attached directly to the ventilator. This is more comfortable than a tube down the throat and may not require sedation. A tracheotomy, can, however, carry risks, including collapsed lung, plugged tracheotomy tube, or bleeding.
• How can I be sure the medical staff knows that we don’t want efforts to restore a heart beat or breathing? The doctor-in-charge should be told as soon as the patient, or the person making health care decisions, decides that medical staff should not do CPR or other life-support procedures. The doctor will then write this on the patient’s chart using terms such as DNR (Do Not Resuscitate), DNAR (Do Not Attempt to Resuscitate), or DNI (Do Not Intubate). Please note that each state has its own DNR policies and procedures and accompanying paperwork. Some states are more specific than California, some less. Only about thirteen states currently use the MedicAlert brand of ID bracelets, and some use wallet cards instead.

If anyone has ever been in an urgent care or emergency room situation, some of these questions may be familiar; yet, at the moment of emotional turmoil, questions such as these may get lost. We hope these examples can help in understanding health care decisions or in having end-of-life conversations.

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