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Health Care Agents - Appointing One and Being One

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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 condition.

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 hospice care.

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