Understanding Treatment Options

When a decision about your care needs to be made,
it is important to have enough information to make an informed decision.

Decisions should be made with full awareness of the risks, benefits, and expected outcomes of treatment. Treatments are considered helpful if they offer cure, relieve suffering, restore functioning or enhance quality of life. The same treatment can be considered harmful if it causes pain or prolongs the dying process without offering benefit.

If you do not understand medical terms or options being discussed, ask questions. 
When weighing the benefit and burden of treatment options, ask your physician if the treatment will make a difference, what the expected side effects are and how will it affect your quality of life.

The decision to refuse treatments and life support is a personal one.
It is legally and ethically appropriate to stop a treatment that is no longer effective and is only prolonging the dying process. If death is the result, it is the underlying disease, not the withdrawal of treatment that causes the death.

Frequently Asked Questions

#1 What is Cardiopulmonary Resuscitation (CPR) and what is a Do Not Resuscitate Order (DNR)?

Whether to resuscitate someone who has a cardiac or respiratory arrest is one of the most common end-of-life medical decisions that individuals & their families must make. CPR is used when someone’s heart and/or breathing stops. Electric shocks (defibrillation) and drugs may also be used to stimulate the heart. If you or your loved one do not wish to receive CPR, your physician must write a do-not-resuscitate (DNR) order in the chart. A DNR order can be revoked at any time for any reason. “Do not resuscitate” does not mean, “do not treat.” A DNR order covers only one type of medical treatment—CPR. Other types of treatment must be addressed separately. Without a DNR, EMTs & medical personnel must initiate CPR. 
(Learn about Tennessee's "POST" Form: for seriously ill patients who may move from one care setting to another.)

Before making a decision about CPR, it is important to understand both the burdens and benefits. CPR’s success rate as portrayed on television is very misleading. In hospitals survival rates are low & can lead to prolonged suffering & severe neurological damage. It is important to address the probability for successful resuscitation based upon the underlying medical condition.

#2 What is Artificial Nutrition and Hydration?

Tube feeding is sometimes started for patients because of family’s fear of letting a loved one “starve to death.” While this fear is understandable, it is not the case. When a person with advanced illness chooses not to eat or accept a feeding tube they are not starving to death. When a dying person’s body begins to shut down, he or she may be unable to adequately use the nutrients that tube feeding would provide and bloating, discomfort and prolongation of suffering may increase. Also a feeding tube may be uncomfortable and sometimes patients must be restrained to keep from pulling it out. It is a natural part of the dying process to refuse food and water. It is important to address your preferences for artificial nutrition and hydration in your advance directive.

#3 What is a Ventilator?

The decision to use a mechanical ventilator (breathing machine) is extremely important and one must understand the risks involved. Decisions to stop a ventilator can cause tremendous suffering for families long after the death of a loved one occurs. A person on a ventilator cannot talk or eat. Because the tube is uncomfortable, medicines are used to keep the person sedated (unconscious) while on a ventilator. After a few days if the person is unable to breathe on his or her own, a tracheotomy may be performed. During this bedside surgery, a tube is inserted directly into the trachea through a hole in the neck. For long-term help with breathing, a trach is more comfortable, and sedation is not needed. For critically ill patients, it may only prolong the dying process.

#4 What is Palliative Care?

Palliative care is specialized medical care for people with serious illnesses – no matter the diagnosis. Its goal is to improve quality of life, by providing relief of the symptoms, pain and stress associated with an illness and the side effects of treatments. Working with a patient’s physicians, a palliative care team of specialists can provide the patient and family with an extra layer of support as they navigate the course of the illness. Patients receiving palliative care have no restrictions on other forms of medical treatment. “Palliative care" and "hospice care" are terms often used interchangeably. Not only is that incorrect, but it also limits access to appropriate services and resources for patients and families early in the course of illness and treatment.

#5 What is Hospice?

Hospice is a philosophy of care that focuses on patient comfort and quality of life rather than on curing disease. Hospice serves patients and family members in equal measure. It uses a multidisciplinary team of physicians, registered nurses, hospice aides, social workers, chaplains and volunteers, all of whom offer emotional support and compassion to help patients and their loved ones during one of life’s most significant journeys. Hospice neither hastens nor postpones dying and is designed to help patients live the remainder of their lives as fully as possible. Just as doctors and midwives lend support and expertise during the time of childbirth, hospice provides its presence and specialized knowledge during the last period of life. Most people, if asked, will say they hope for a peaceful, comfortable death surrounded by loved ones. A hospice patient’s team of professionals helps make this possible.

In most instances, hospice is provided in the home. However, for patients who are unable to be cared for at home or who may be experiencing a medical crisis, there are three inpatient facilities operated by Alive Hospice in Davidson County. Hospice care can be provided to patients wherever they ‘live”. This means a patient living in a nursing or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the facility.

#6 What is the POST form? Physician Orders for Scope of Treatment

Physician Orders for Scope of Treatment, or “POST” is a tool that gives seriously ill or frail patients more control over the types of health care treatments they receive toward the end-of-life. Signed by both patient and physician, Tennessee’s POST form ensures that a patient’s wishes become actionable physician’s orders that are entered into the patient’s medical record and adhered to by health care providers even if patients move from one care setting to another. This means that if a patient is moved, for example, from home or a skilled nursing facility to a hospital, his POST moves with him to ensure that all of the health care providers involved - including any Emergency Medical Technicians (EMTs) who transport him - will know his specific health care wishes, even if he is no longer able to communicate.