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

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

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

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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

Get the facts

Your options

  • Stop treatment that prolongs your life. Instead, receive only
    treatment that focuses on your comfort and quality of life.
  • Don't stop treatment that prolongs your life.

Key points to remember

  • If there is a good chance that your illness
    can be cured or managed, your doctor may advise you to first try available
    treatments. If these don't work, then you might think about stopping
    treatment.
  • If you stop treatment, you will still receive care that
    focuses on pain relief, comfort, and the quality of your life. This is called
    hospice 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.
  • Even though treatment focuses on helping you live longer,
    it may cause side effects that can greatly affect your quality of life and your
    ability to spend time with your family and friends.
  • If you still
    have personal goals that you want to pursue, you may want treatment that keeps
    you alive long enough to achieve them.
FAQs

What kinds of treatment can help you live longer?

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.

What is palliative care? What is hospice care?

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.

Why might you choose treatment to prolong your life?

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.

What should you think about before you decide to stop treatment that prolongs your life?

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?

What should you discuss with your doctor before you make a decision?

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.

Why might your doctor recommend that you stop treatment?

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.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Stop treatment to
prolong your life

Stop treatment to
prolong your life

  • You receive treatment that
    focuses on managing your symptoms and quality of life instead of curing or
    slowing the progression of your illness.
  • You avoid the side effects of
    treatment.
  • You can focus on being comfortable, spending time with
    your family and friends, and making any arrangements that you need to
    make.
  • You may die
    sooner.
  • You may not be able to pursue or achieve your personal goals
    before you die.
Don't stop treatment

Don't stop treatment

  • You receive treatment that
    may cure or slow the progression of your illness.
  • You may live longer or, in
    rare cases, be cured of your illness.
  • You may be able to pursue and
    achieve your personal goals.
  • Treatment may
    cause side effects that may affect your quality of life and your ability to
    spend time with your family and friends.
  • Treatment may stop working, so you may not get better.

Personal stories about care options at the end of life

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When I was
recently diagnosed with cancer of the lung, my doctor discussed treatment
options with me and my family. The tumor in my lung cannot be surgically
removed. Chemotherapy may prolong my life somewhat, but I don't want to risk
the side effects associated with these medicines. I have lived a long, full
life and I want to die comfortably at home with my family. I want to remain
active as long as possible. I am willing to allow hospice to help my family
care for me when I need additional help.

Tully, age 83

About a year
ago I was diagnosed with acute leukemia. I went into remission shortly after I
started chemotherapy. Unfortunately, this remission was only brief, and I am
back on chemotherapy and radiation therapy. I have small children at home and
want to see them grow. My doctor has informed me that I may need to try other
forms of treatment, such as a bone marrow transplant. I am willing to pursue
treatment that may cure my illness. If I develop complications, I want to
receive any treatment that would keep me alive.

Mia, age
32

I have had AIDS for 3 years. I have taken
many medicines, but I am now getting frequent infections that do not
respond to the medicines. I have spoken to my partner, family, friends, and
doctor and do not want to receive CPR or be placed on a ventilator if I stop
breathing. I don't feel comfortable dying at home, because I am concerned about
the welfare of my partner. I have chosen to live at my home as long as I
possibly can, then move to a hospice house in my hometown. This way, a hospice
team can help manage my symptoms, and my partner and other family members can
participate in my care.

Marion, age 39

I was just 33 when I had my first heart
attack. My heart disease has progressed in spite of medicines, bypass
surgery, and lifestyle changes. Other than my heart disease, I'm pretty
healthy. My remaining treatment option is a heart transplant. Without this, I
am likely to die. Even after the heart transplant, I will need to take a lot of
medicines, continue my healthy lifestyle, and see my doctor often. I live a
productive life and am willing to have a heart transplant if it will prolong
my life.

Javier, age
54

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to stop treatment that prolongs life

Reasons not to stop treatment

I'm ready to face my death and let my illness take its natural course.

I want to try every possible treatment to stay alive, even if there is little chance that I might survive.

More important
Equally important
More important

I've already met the goals I set out to achieve in my life.

I still have personal goals I want to pursue and achieve.

More important
Equally important
More important

The side effects from my treatment are making me feel worse.

I feel better than I did before I started treatment.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Stopping treatment

NOT stopping treatment

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, When you stop treatment, does it mean that you stop receiving care?
2, Can you receive treatment again even though you decided to stop?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Jean S. Kutner, MD, MSPH - Geriatric Medicine,
Specialist Medical Reviewer Robin L. Fainsinger, MBChB, LMCC, CCFP - Palliative Medicine
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Stop treatment that prolongs your life. Instead, receive only
    treatment that focuses on your comfort and quality of life.
  • Don't stop treatment that prolongs your life.

Key points to remember

  • If there is a good chance that your illness
    can be cured or managed, your doctor may advise you to first try available
    treatments. If these don't work, then you might think about stopping
    treatment.
  • If you stop treatment, you will still receive care that
    focuses on pain relief, comfort, and the quality of your life. This is called
    hospice 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.
  • Even though treatment focuses on helping you live longer,
    it may cause side effects that can greatly affect your quality of life and your
    ability to spend time with your family and friends.
  • If you still
    have personal goals that you want to pursue, you may want treatment that keeps
    you alive long enough to achieve them.
FAQs

What kinds of treatment can help you live longer?

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.

What is palliative care? What is hospice care?

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.

Why might you choose treatment to prolong your life?

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.

What should you think about before you decide to stop treatment that prolongs your life?

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?

What should you discuss with your doctor before you make a decision?

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.

Why might your doctor recommend that you stop treatment?

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.

2. Compare your options

  Stop treatment to
prolong your life
Don't stop treatment
What is usually involved?
  • You receive treatment that
    focuses on managing your symptoms and quality of life instead of curing or
    slowing the progression of your illness.
  • You receive treatment that
    may cure or slow the progression of your illness.
What are the benefits?
  • You avoid the side effects of
    treatment.
  • You can focus on being comfortable, spending time with
    your family and friends, and making any arrangements that you need to
    make.
  • You may live longer or, in
    rare cases, be cured of your illness.
  • You may be able to pursue and
    achieve your personal goals.
What are the risks and side effects?
  • You may die
    sooner.
  • You may not be able to pursue or achieve your personal goals
    before you die.
  • Treatment may
    cause side effects that may affect your quality of life and your ability to
    spend time with your family and friends.
  • Treatment may stop working, so you may not get better.

Personal stories

Personal stories about care options at the end of life

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When I was recently diagnosed with cancer of the lung, my doctor discussed treatment options with me and my family. The tumor in my lung cannot be surgically removed. Chemotherapy may prolong my life somewhat, but I don't want to risk the side effects associated with these medicines. I have lived a long, full life and I want to die comfortably at home with my family. I want to remain active as long as possible. I am willing to allow hospice to help my family care for me when I need additional help."

— Tully, age 83

"About a year ago I was diagnosed with acute leukemia. I went into remission shortly after I started chemotherapy. Unfortunately, this remission was only brief, and I am back on chemotherapy and radiation therapy. I have small children at home and want to see them grow. My doctor has informed me that I may need to try other forms of treatment, such as a bone marrow transplant. I am willing to pursue treatment that may cure my illness. If I develop complications, I want to receive any treatment that would keep me alive."

— Mia, age
32

"I have had AIDS for 3 years. I have taken many medicines, but I am now getting frequent infections that do not respond to the medicines. I have spoken to my partner, family, friends, and doctor and do not want to receive CPR or be placed on a ventilator if I stop breathing. I don't feel comfortable dying at home, because I am concerned about the welfare of my partner. I have chosen to live at my home as long as I possibly can, then move to a hospice house in my hometown. This way, a hospice team can help manage my symptoms, and my partner and other family members can participate in my care."

— Marion, age 39

"I was just 33 when I had my first heart attack. My heart disease has progressed in spite of medicines, bypass surgery, and lifestyle changes. Other than my heart disease, I'm pretty healthy. My remaining treatment option is a heart transplant. Without this, I am likely to die. Even after the heart transplant, I will need to take a lot of medicines, continue my healthy lifestyle, and see my doctor often. I live a productive life and am willing to have a heart transplant if it will prolong my life."

— Javier, age
54

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to stop treatment that prolongs life

Reasons not to stop treatment

I'm ready to face my death and let my illness take its natural course.

I want to try every possible treatment to stay alive, even if there is little chance that I might survive.

             
More important
Equally important
More important

I've already met the goals I set out to achieve in my life.

I still have personal goals I want to pursue and achieve.

             
More important
Equally important
More important

The side effects from my treatment are making me feel worse.

I feel better than I did before I started treatment.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Stopping treatment

NOT stopping treatment

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
When you stop treatment, does it mean that you stop receiving care?

  • Yes

  • No
  • I'm not sure

That's right. If you stop treatment, you will still receive care that focuses on pain relief, comfort, and your quality of life.

2.
Can you receive treatment again even though you decided to stop?

  • Yes
  • No

  • I'm not sure

That's right. 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.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Jean S. Kutner, MD, MSPH - Geriatric Medicine,
Specialist Medical Reviewer Robin L. Fainsinger, MBChB, LMCC, CCFP - Palliative Medicine

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