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Life-Threatening Illness
End-of-life Decisions
Caring for a person with cancer starts after symptoms begin and the diagnosis is made and continues until the patient is in remission, is cured, or has died. End-of-life decisions should be made early after the diagnosis, before there is a need for them.
These issues are not pleasant or easy to think about. They usually reflect a person's philosophical, moral, religious, or spiritual background. If a person has certain feelings about end-of-life issues, they should be made known so that they can be carried out. However, since these are sensitive issues, they are frequently not discussed by patients, families, or doctors. People often feel that there will be plenty of time to talk later about the issues. Many times, though, when the end-of-life decisions are necessary, the patient and family are not able to make the decisions, and the decisions are made by people who may not know the patient's wishes.
As a first step in making decisions for the end of life, patients should complete a Health Care Proxy (HCP) form. These forms are not the same in each state, but they have the same purpose. The HCP allows the patient to identify a person (called a proxy) to make medical decisions if the patient becomes unable to do so. The form may not need to be notarized, but it must be witnessed by two other people. In some states, the HCP is better than a living will because the patient does not have to say exactly which decisions need to be made, but that the proxy knows "what I would want."
A living will is similar to the HCP. It allows a person to state in more detail what his or her feelings are about medical care, nutrition, and other medical issues so that doctors and caregivers can carry out these wishes. Living wills are not available or legal in all states. Living wills usually require a lawyer and notarization to be complete in states where they are recognized.
Do Not Resuscitate (DNR) orders tell doctors and other health care givers that a patient does not want extreme measures to be taken to save his or her life. The patient will not be resuscitated if his or her heart stops or if he or she stops breathing. People who do not want extreme measures taken should talk with their doctor and other caregivers and complete forms as early as possible (for example, when they are admitted to the hospital) instead of waiting until they cannot make this decision. Although people with end-stage disease and their families are usually uncomfortable talking about these issues, doctors and nurses may gently and respectfully bring up the issues when the time is right.
Programs like hospice are now available that allow patients to die at home. Some states have DNR forms available for people wishing to die at home which protects them from being resuscitated. These advanced directive forms are signed by the patient's doctor and express the patient's wishes and intent not to be resuscitated. These issues are important to discuss wherever a patient is being cared for, whether at home, in the hospital, at hospice, in a nursing home, or elsewhere.
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