Health Care Agents - Appointing One and Being One
What do I need to know to make decisions? continued...
Therefore, information about the patient's prognosis is particularly
important. What, given the present situation, is the most likely outcome?
Although the outcome may never be known absolutely, you can ask what chance the
patient has to return to his or her previous condition, or if that is not
realistic, what is the best outcome that could be expected? The worst?
If the doctor says the patient may improve with treatment, what does
"improve" mean? To a doctor "improve" might mean survival, but
with serious brain damage. You may know that the patient would not want
treatment if that was the most likely outcome.
If the doctor says that the patient has a treatable condition, such as
pneumonia, but this treatment cannot affect the underlying disease, such as
advanced Alzheimer's disease, you may know that the patient would not want life
prolonged under these circumstances. Or you might decide that because of other
aspects of the patient's condition (for example, advanced cancer), further
treatment would only prolong the patient's dying in an uncomfortable or painful
It could be an appropriate decision to refrain from treating the pneumonia
and concentrate only on treatments that would keep the patient comfortable.
(Such treatments are commonly called palliative care.)
You also can ask the physician to describe how the patient's disease is
likely to progress and what decisions are likely to be necessary at some point.
For example, a patient with Alzheimer's disease eventually might stop eating or
become unable to swallow.
You can begin to consider whether artificial nutrition and hydration should
be given if that happens, and obtain specific information about these
treatments. If someone is very sick, it is likely that at some point they will
have cardiac or pulmonary arrest (their heart will stop beating or they will
stop breathing). Start talking with the doctor early about whether or not a
do-not-resuscitate (DNR) order should be written to prevent the use of
cardiopulmonary resuscitation (CPR).
In discussing whether to withhold or withdraw particular treatments, you
should also ask the physician about the care that the patient would continue to
receive. You should expect a palliative care plan to be in place to manage any
pain or discomfort. You can consider non-hospital options for the patient's
care. For example, appropriate care might be delivered more effectively in a
long-term care facility or it could be given at home with home-care support or