Advance Care Planning: Should I Stop Treatment That Prolongs My Life?

There are several kinds of treatment that can help you live longer. These may be needed for only a short time until your illness improves. Or you may use them over the long term to help keep you alive.

Some treatments include the use of:

• Medicines to slow the progress of certain diseases, such as heart disease, diabetes, cancer, AIDS, or Alzheimer's disease.
• Antibiotics to treat serious infections, such as pneumonia.
• Dialysis to clean your blood if your kidneys stop working.
• A breathing machine to help you breathe if you can't breathe on your own. This machine pumps air into your lungs through a tube inserted into your throat.
• A feeding tube or an intravenous (IV) line to provide food and fluids if you can't eat or drink.
• Cardiopulmonary resuscitation (CPR) to try to restart your heart.

The decision to receive treatments that may help you live longer is a personal one. You may want your doctor to do everything possible to keep you alive, even when your chance for recovery is small.

Or you may choose hospice care, which focuses more on how well you live rather than how long you live. It looks for ways to make you more comfortable, such as helping to manage your pain and other symptoms.

These can be tough decisions to make, but you don't have to make them alone. Look to your family, your doctor, your spiritual advisor, and your friends for help and support.

Palliative care is a kind of care for people who have serious illnesses. It focuses on relieving pain and other symptoms and improving your quality of life-not just in your body but also in your mind and spirit.

The kind of care you get depends on what you need. Your goals and values guide your care. You can still get treatment for your illness at the same time as you get palliative care to help with the side effects of treatment. But there may come a time when you decide that palliative care is more important.

If you choose to stop treatment, your doctor, nurses, and others who provide care will focus on easing your symptoms and providing emotional and spiritual support for you and your family. They can help you and your loved ones:

• Better understand your illness.
• Talk more openly about your feelings.
• Decide what treatment you want or don't want.
• Plan for the future.

They can also make sure that the rest of your health care team and your family and friends understand your goals and respect your wishes.

When you, your loved ones, or your doctors feel that you only have a short time left to live, you may want to think about hospice care. Hospice provides palliative care for people who are in their final weeks or months of life. Hospice services include managing pain and other symptoms and keeping you as comfortable as possible in a familiar environment with your family and friends. Hospice programs also provide services to support the needs of your family, friends, and other caregivers.

If you choose to focus only on palliative or hospice care, you will still have access to doctors and excellent care. A decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind if your health starts to improve.

You might consider treating your illness if:

• There is a good chance that it can be cured or managed.
• You think you can manage the possible side effects of treatment.
• You don't think treatment will get in the way of your quality of life.
• You have personal goals that you still want to pursue and achieve.

You might ask yourself what kinds of treatments you may want if:

• You have a serious illness that can't be cured.
• You slip into a coma and there is little chance that you'll come out of it.
• You have a long-term illness that gets worse over time, with no chance of getting better or being cured.

You might think about what your doctor says about your chances for recovery and how that might affect what you decide to do.

Even though medical treatments may help to prolong your life, they may also cause pain and other side effects that can greatly affect your quality of life and your ability to spend time with your family and friends.

You might also ask yourself what "quality of life" means to you and how much control you want to have over it.

• Do you want to be able to function and live on your own?
• Are you okay with living in a hospital or nursing home?
• Are you okay with being kept alive by machines?

It can be hard to decide when to stop treatment. But there are some questions you can ask your doctor to help make things more clear, such as:

• Is it possible to cure my illness? Some health problems can be cured or managed successfully for many years with available treatments. Other illnesses get worse quickly and can't be cured.
• What are my treatment options? Many treatments can cure or treat an illness with little effect on your quality of life. But some treatments may cause side effects that can greatly lower your quality of life.
• How long do you think I have left to live? It may be hard for your doctor to know when your life will end. But he or she may be able to estimate how much time you might have left, based on how well you respond to treatment and how much your illness has progressed.

If you don't already have an advance directive, this may be a good time for you to prepare one. An advance directive is a legal document that describes the kinds of medical care you want to receive and how you want your health care wishes carried out if you're near the end of your life or are in a hospital with a serious illness. It tells your family and your doctor what to do if you can't speak for yourself.

Your doctor may suggest that you stop treatment that prolongs your life if:

• Your chance of surviving your illness is very low.
• You have tried all possible treatments for your illness, but they haven't helped.
• You can no longer deal with the side effects of treatment.