Stopping Life-Sustaining Treatments

What are life-sustaining treatments?

Life-sustaining treatments help keep you alive if a vital body function fails. These treatments can include cardiopulmonary resuscitation (CPR) and the use of machines to help with heart, lung, or kidney function. They can also include the use of tubes to deliver food, fluids, blood, and medicines to the body. Blood transfusions and antibiotics are also types of life-sustaining treatments.

What happens if life-sustaining treatments are continued?

These treatments can help extend your life, but not cure your illness. If you are near the end of your life, you may find it hard to handle the side effects and problems that can occur with these treatments. In this case, the treatments may be too much of a burden on your body. They may cause more harm than good. They may also disrupt the natural dying process and prolong suffering.

What happens if life-sustaining treatments are stopped?

If these treatments are stopped, the focus of treatment will shift to comfort care. This involves measures to control pain and other symptoms you may have. These measures are not meant to cure your illness or help you live longer. Instead, they are meant to improve your quality of life during the time you have left. If you are in the end stage of your illness, you may be referred to hospice by your healthcare provider. Hospice provides end-of-life care. This includes emotional, spiritual, and social support for you and your loved ones.

How do I decide whether to stop life-sustaining treatments?

Your healthcare provider and healthcare team will talk with you about the specific treatments that are part of your care plan. If you want, you may include family and friends in these meetings. Here are some questions to think about or ask your healthcare team:

• Is there a chance that my illness will improve? Or will it continue to get worse?

• What are my goals of care? Do I want to extend the time I have left? Or do I want to focus my care on comfort and managing symptoms?

• How will stopping or continuing these treatments affect my health? Will they enhance my comfort and quality of life? Or will they cause more problems?

Consider your own values or faith. Also, ask for advice from those who share your values.

How do I state my decisions about life-sustaining treatments?

Once you’ve made your decision to continue or stop specific treatments, you can tell your healthcare provider directly. It's best to also put your treatment wishes in writing with advance directives. These are legal forms related to healthcare decisions. Laws about advance directives vary from state to state. Ask your healthcare provider about what forms are needed to make sure your wishes will be followed. Some common forms include:

• A durable power of attorney for healthcare or a healthcare proxy form. This form lets you name a person to make treatment decisions for you when you can’t. This person is often called a healthcare proxy, medical or healthcare power of attorney, or agent.

• A living will. This form tells others the kinds of treatment you want or don’t want if you become too ill or injured to speak for yourself.

• Orders for life-sustaining treatments. These are actual healthcare provider's orders that must be followed by other medical providers. The form belongs to you, not to the healthcare provider or hospital. These are legal forms obtained from your healthcare provider or hospital that document your wishes. The forms are known by different names depending on the state. Common names include:

  • MOLST (medical orders for life-sustaining treatment)

  • POLST (physician orders for life-sustaining treatment)

  • MOST (medical orders for scope of treatment)

  • POST (physician orders for scope of treatment)

  • TPOPP (transportable physician orders for patient preferences)

   

Keep in mind that you can change or cancel an advance directive at any time. Make it a practice to review your decisions each time there is a change in your health or goals of care. Also, be sure to tell your healthcare proxy and loved ones of any changes in your decisions.

Deciding whether to stop life-sustaining treatments for a loved one

The decision to stop treatment ideally is made with the person’s consent. If the person is not capable of making decisions and has no advance directive, the decision falls to the person’s healthcare proxy or another adult. If you need to make a decision about stopping treatment for a loved one, start by talking with their healthcare provider. Review the goals of care and the benefits and burdens of specific treatments on your loved one’s health. Also think about your loved one’s wishes and values. If needed, seek advice from other healthcare team members, like a social worker or spiritual adviser.