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Care at the End of Life


Topic Overview

What decisions do you need to make about care at the end of life?

You will face many hard decisions as you near the end of life. Those decisions will include what kind of care you'd like to receive, where you'd like to receive care, and who will make decisions about your care should you not be able to make decisions yourself.

You may hear these terms:

  • Curative treatment, which is any medical treatment that is given to cure your disease or to try to help you live longer.
  • Palliative care, which helps to provide relief from pain and any other symptoms you may have with your disease. The palliative care team will help coordinate your medical care with other doctors and help you with medical decisions. Palliative care also provides emotional and spiritual support for you and your loved ones.
  • Hospice care, which provides palliative care for people who are close to the end of life.

No one knows when his or her time may come. So it's a good idea to spend some time planning what you want at the end of life. To be prepared:

  • Decide what kind of health care you want or don't want. For example, you can decide whether you want CPR if your heart or breathing stops.
  • Let others know what you've decided. Consider writing an advance directive that includes a living will and a medical power of attorney (also called a durable power of attorney). A living will is a legal document that expresses your wishes for medical care if you are not able to speak or make decisions for yourself. A medical power of attorney lets you choose a health care agent. Your health care agent will have the legal right to make treatment decisions for you, not only at the end of your life but anytime you are not able to speak for yourself.
  • Decide whether you'd like to donate your organs.

Will you have to choose between types of care?

One thing to think about is what type of medical care you want. Some people ask their doctors to do everything possible to keep them alive. This is called curative treatment.

Others choose palliative care, which does not try to cure your illness. It looks at ways to make you more comfortable. For example, palliative care may include giving you medicines to help with pain or with the side effects from treatment. Palliative care team members may also provide physical therapy or help you if you are having problems such as anxiety or loss of appetite from chemotherapy.

You can have both types of treatment. You can get palliative care to help keep you comfortable, and you can take medicines or other treatments that might cure you.

A time may come when you decide to stop curative treatment if it is very clear that your illness can't be cured. You will still see your doctor and get excellent care. And if your condition changes, you can start curative treatment again. But if your illness is expected to get worse, you may want to plan ahead for that time by talking with your doctor. He or she will be the one to refer you for hospice care.

Hospice care is for people who are close to the end of life and are not likely to live for more than 6 months.

Where would you like to receive care as you are dying?

Another thing to think about is where you'd like to receive care. Some people would rather be cared for in a hospital. Others choose to be cared for at home or in a nursing home.

If you have only a few months left, you may choose to receive care through hospice. Hospice services are provided by a team of people that includes doctors, nurses, and volunteers. The team gives palliative care and emotional and spiritual support to people near the end of life and to their families. It may offer practical support like running errands or fixing meals. You can get hospice care in your home or in a hospice center, hospital, or nursing home.

The costs are usually covered by Medicare, Medicaid, or private insurance. If you don't have any coverage, a hospice will probably work with you and your family to make sure you can receive their services.

What do you and your doctor need to know?

If you find out that you have a life-threatening disease or condition, talk with your doctor about the kind of medical care you'd like to receive. Ask a lot of questions about your illness and the treatments that are available. It can be helpful to have a friend or family member go to your appointments with you.

When you have decided whether you want palliative care or curative treatment or both, tell your doctor. Also, share your advance directive with your doctor.

How do you talk with your loved ones about your end-of-life choices?

It can be hard to talk with your loved ones about death. But it is important to discuss your choices while you can speak for yourself. Planning ahead will help you and your loved ones make hard decisions when the time comes.

Even though it might be awkward or uncomfortable, look for chances to talk about your end-of-life choices. For example, you could bring up the subject while you are making out your will. Or you could talk with loved ones after a visit to the doctor. Family gatherings are another place to make time to discuss your plans with loved ones.

Whatever you decide and whenever you decide to talk with loved ones, be sure to put your wishes in writing. You can always change your mind if your condition or your wishes change.

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