Frequently Asked Questions:
Health Care Treatment
Do doctors, nurses and hospitals have to follow my instructions?
Yes, unless they inform you in advance that they cannot. In that case, they are required either to give you a reasonable opportunity to transfer to a physician or health care provider who will comply with your wishes, or to help you find one who will. Health care professionals cannot simply ignore your wishes.
What is cardiopulmonary resuscitation (CPR)?
CPR is pressing on your chest to keep blood flowing and also assistance with breathing, such as mouth to mouth assistance. Sometimes electrical shocks are used to help start the heart. CPR is used only for short periods until a person can get to the hospital.
Does CPR always work?
No. It depends on things such as your overall health and your age. It does not work very well for most people who have a life-threatening illness or who are very old.
What is artificial respiration or ventilation?
This means getting assistance with breathing when you can’t breathe on your own. A tube is put into your nose, mouth or into your windpipe. If this tube is needed for more than a few weeks, a surgeon will probably need to put the tube directly into your throat. Doing this causes problems with talking, eating and drinking. The tube is also attached to a machine, which makes it harder to move around.
What is Palliative Care?
Palliative care is a method of providing comfort care. The goal is to prevent or treat symptoms and side effects of a disease. It should be part of the plan from the first day a serious illness is diagnosed. Palliative care can be provided regardless of how long you are expected to live.
Palliative care can provide:
• Relief of pain and other symptoms
• Emotional and spiritual support for you and your family
• Help with making complex treatment decisions
What is Hospice Care?
Hospice care is a level of comfort care provided to those who are expected to die within the next 6 months. The focus is on symptom management, a peaceful death, and life after death. As your health declines, hope shifts to the meaningful time with family and friends.
Hospice care can give all the benefits listed for palliative care plus:
• Physical therapy or occupational therapy to help develop new energy or conserve energy
• Art, music, and other complementary therapies
• Respite care to provide a break for caregivers
• Home health aides to help with bathing, grooming, eating and other personal health needs.
• Trained volunteers for support like running errands and meal preparation
• Support services for caregivers including grief counseling
Can you tell me more about organ donation?
Consider these facts about organ donation when making your decision:
• More than 3000 people in the upper Midwest are waiting for a transplant.
• Organ donation may help your family in the grieving process. One person can save or heal up to 60 lives.
• There is no cost to you or your family when you donate organs.
• Even if you have health conditions, you will likely be able to donate.
• All major religions support organ donation.
• Organ donation will not affect any funeral plans for viewing.
• Organ donations are confidential.
What is the likely outcome of CPR?
CPR can save lives, but the success rate is low. Your age, health, and illness can affect the outcome. When CPR is started on older, weaker people in nursing homes, about 1 out of 30 survives. CPR works best if you are in mostly good health and it is started quickly. When it is started in the hospital about 1 out of 5 survives. Even if you survive, complications can occur during CPR that may cause more health problems.
Health care after CPR may involve care in an ICU (intensive care unit) for:
• A ventilator to support breathing
• Damage to your ribs
• Possible brain damage from being without oxygen
How do I state my decision about CPR?
In the hospital, your doctor and other health care providers will do CPR when needed unless you tell them not to or have your wishes written in an advance care plan. If you choose not to have CPR, a Do Not Resuscitate (DNR) order is written by the doctor. This order tells health care providers not to do CPR if your heart and lungs stop working. You may change this decision any time.
What is a ventilator or BiPap?
• A ventilator is a machine that helps a person breathe. The machine is connected to a tube that goes through your nose or mouth and into the windpipe. It pushes air into your lungs if you are too weak to breathe on your own. A ventilator can be used for a few hours to a few months or years.
• BiPap (bi-level positive airway pressure) pushes air into your lungs through a face mask that fits tightly over your mouth and nose. Possible concerns with ventilators or BiPap
• You may need to be cared for in an intensive care unit (ICU).
• You may need medicine to keep you drowsy or asleep.
• You cannot speak or swallow when the ventilator tube is in your windpipe.
• The ventilator may not work well if your body is shutting down from long-lasting health problems.
• For long-term use the breathing tube may be placed into an opening made in your throat (tracheotomy).
• With a BiPap mask, some of the air may go into your stomach and cause gas pain. Wearing a mask, it may be difficult to talk or eat.
What if I do not want a ventilator or BiPap?
If you are not able to breathe on your own or with a breathing machine, you will die naturally. You can be kept comfortable.
What is kidney dialysis?
Dialysis is a treatment that does the work of the kidneys by filtering the blood. There are 2 types of dialysis:
• Hemodialysis removes fluids and wastes from the blood using a filter. Blood flows from your body to the dialysis machine then through a special filter, called a dialyzer or an artificial kidney, and back to your body again. As blood goes through the dialyzer, fluid and wastes are taken out.
• Peritoneal dialysis (PD) is a treatment for kidney failure that uses the body’s own peritoneal membrane in the belly as a filter. PD is done about four times every day at the normal breaks in the day: morning, noon, evening, and bedtime.
What happens if I choose not to have dialysis?
All patients have the right to decide not to start dialysis. If you started dialysis, you have the right to stop. Choosing no treatment or stopping dialysis will cause a natural death within a few days to a few weeks. You also have the right to start dialysis again if you change your mind.
What is artificial feeding and artificial hydration?
Artificial feeding (feeding tube) or artificial hydration are used to support your body if you can no longer take in food or fluids by mouth. Some types of tubes used include:
• An NG tube (nasogastric) can be placed through the nose and into the stomach. It sends formula and water directly to the stomach.
• A G tube (gastrostomy) or PEG tube (percutaneous endoscopic gastrostomy) can be placed through a small hole in the belly. It sends formula and water directly into the stomach.
• An IV line (intravenous) line is placed into a vein. It sends nutrition and fluids directly into the blood vessels. Possible concerns about artificial feeding Risks can include bleeding or infection at the tube site and problems with the tube. Inhaling the formula by accident can cause pneumonia, a life-threatening problem. A swollen belly, belly discomfort, and diarrhea can be burdens of tube feedings.
What happens if I choose to have artificial feeding?
Artificial feedings may help you feel better and improve your quality of life for a time. If you are near the end of your life, it may be hard to tolerate the problems that can occur with the treatment.
What happens if I choose not to have artificial feeding?
If you cannot take in any food by mouth and choose not to have artificial feeding, your body will slowly shut down. Death will likely occur within a few days or weeks. You may find it reassuring to know that most patients near the end of life do not typically feel hunger or thirst.
What are possible concerns about artificial hydration?
Artificial hydration can cause too much fluid to build up in the body. This can cause uncomfortable swelling in the arms, legs, and belly. Fluid can also build up in the lungs, which can cause trouble breathing and shortness of breath. Risks also include bleeding and infection at the tube site.
What happens if I choose to have artificial hydration?
Artificial hydration will help your body function. This may increase comfort and improve quality of life for a time. If you are near the end of your life, you may find it hard to tolerate the problems that can occur with this treatment.
What happens if I choose not to have artificial hydration?
Without enough fluids, the body will slowly shut down. Death will occur within a few days or weeks. You may find it reassuring to know that dehydration is a natural part of the dying process. Most patients near the end of life do not feel thirst. In the last days of life, dehydration may help trigger the release of chemicals in the brain that can leave you with a sense of calm and well-being. This may help you pass your final hours in greater comfort.
What is an implantable cardiac device and why would it be deactivated?
Implanted cardiac defibrillators (ICD) or left ventricular assistive devices (LVAD) can be used to support your heart function. There may come a time when you wish to deactivate these devices and have a natural death. It will help to talk to your doctor about this ahead of time and have a plan in place.
Can you tell me more about antibiotics at the end of life?
Sometimes death occurs as a result of an infection rather than a medical problem such as cancer or heart disease. Some examples of serious infections are pneumonia and sepsis. You can decide to treat infections or not depending on your wishes and long-term health outcome. Antibiotics are medicines used to treat infections caused by bacteria. Other medicines can be used to treat viruses or fungal infections. These medicines would be given through an IV.