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Making Decisions About the End of Life

Critical Care

Making decisions about the end of life has become very difficult because newer machines make it possible for people to live longer, even when there is little chance they can have a good quality of life. Americans are dying more and more of sicknesses that slowly wear down the body. With these sicknesses some patients lose the ability to make decisions. Not long ago, it was believed that a patient's doctor was the best person to make decisions about the end of life -- after all, by spending years getting to know a patient, the doctor should understand both the medical issues and the patient's wishes about end of life treatment. In America now, people have the right to make these decisions for themselves, so this role of the doctor has changed. Doctors still help in the decision-making process, but they no longer make the decisions for their patients.

Though there are different ways of putting your wishes in writing before you ever become very sick, it is important to talk about these issues and make them known to family members and to your doctors and nurses. The more clearly you explain your values and choices to friends and loved ones, the more likely it is that they will be able to follow your wishes if you are unable to make health care decisions yourself.

"Advance directives" are the written words used to describe the wishes you want carried out if you get very sick and you are no longer able to tell family members and doctors what treatments you wish to receive. Writing down advance directives for yourself is very helpful, but it is only part of what you need to do. It is also important that you talk with people such as family members and your doctors to let them know your wishes.

Doctors and hospital staff want to find out what they should do by getting this information from you. They always prefer to hear patients say what treatments they do and don't want. If the patient is not able to speak clearly or is not competent*, doctors depend upon a living will, a health care proxy (see what these mean below), or close family members. If the patient has not talked this over with anyone or has not created a living will or health care proxy, then family members are often left to make decisions about what the patient would have wanted to do. Family members may feel uncomfortable making these decisions on behalf of the patient.

*Generally speaking, if a patient is alert and awake and is able to understand the risks, benefits, and effects of different treatment choices, then he or she is considered "competent" to make medical decisions.