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Definition

Sometimes after injury or a long illness, the main organs of the body no longer work properly without support. Your health care provider may tell you that these organs will not repair themselves.

Medical care to prolong life can keep you alive when these organs stop working well. The treatments may extend your life, but do not cure your illness. These are called life-sustaining treatments.

Life-sustaining Treatments

Treatments to extend life can include the use of machines. This equipment does the work of the body organ, such as:

• A machine to help with breathing (ventilator)
• A machine to help your kidneys (dialysis)
• A tube into your stomach to provide food (nasogastric or gastrostomy tube)
• A tube into your vein to provide fluids and medicines (intravenous, IV tube)
• A tube or mask to supply oxygen

Making the Decision for Yourself

If you are near the end of your life or you have an illness that will not improve, you can choose what kind of treatment you want to receive.

You should know that the illness or the injury is the main cause of the end of life, not the removal of life support equipment.

To help with your decision:

• Talk to your providers to learn about life support care you are receiving or may need in the future.
• Learn about the treatments and how they would benefit you.
• Learn about side effects or problems the treatments might cause.
• Think about the quality of life you value.
• Ask your provider what happens if life support care is stopped or you choose not to start a treatment.
• Find out if you will have more or less pain or discomfort if you stop life support care.

These can be hard choices for you and those close to you. There is no hard and fast rule about what to choose. People's opinions and choices often change over time.

Making Your Wishes Known

To make sure your wishes are followed:

• Talk to your providers about your choices.
• Write your decisions in an advance health care directive.
• Find out about a do-not-resuscitate (DNR) order.
• Ask someone to be your health care agent or proxy. Be sure this person knows your wishes and if you make any changes in your health care choices.
• A family member, attorney, community social worker, or senior services may help you ensure that your wishes are honored and the proper documents are completed.

As your life or health changes, you may also change your health care decisions. You can change or cancel an advanced care directive at any time.

Making the Decision for a Loved one

You may serve as a health care agent or proxy for someone else. In this role you may have to make the decision to start or remove life support machines. It may be a very hard decision to make.

If you need to make a decision about stopping treatment for a loved one:

• Talk to your loved one's providers.
• Review the goals of your loved one's medical care.
• Weigh the benefits and burdens of treatments on your loved one's health.
• Think about your loved one's wishes and values.
• Seek advice from other health care professionals, such as a social worker.
• Seek advice from other family members.

References

Arnold RM, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

Shah AC, Donovan AI, Gebauer S. Palliative medicine. In: Gropper MA, ed. Miller's Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 52.

Shreves A, Quest TE. End of life. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap e5.

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