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Life can often throw us a hard ball that is really difficult to catch, and sometimes you simply just don’t want to play ball at all. That is how it can feel when you are faced with making the final decision on a loved one’s life. When is the right time to turn off their life support?
Life support replaces or supports a failing bodily function. In treatable or curable conditions, life support is used temporarily until the body can resume normal functioning. But, in situations where a cure is not possible, life support may prolong discomfort.
Usually, families and the medical team (doctors and nurses) make decisions together about life support although sometimes doctors make the final when ultimately necessary. This depends on the type of decision, as well as on what families want. You can let your loved one’s doctor know how you would prefer decisions to be made in advance so everyone is clear on instructions.
There are different ways that decisions are made about life support. It is important that you let the doctors know how much you want to be involved in the decisions that are made.
Sometimes a treatment is very unlikely to work or because parents do not wish to make a decision about treatment and therefore there may be no other option available. In these situations, doctors will still take into account the views of others about treatment. Most times, though, the decision is shared between families and the medical team.
Family members often have mixed feelings about who should make decisions. One part of them feels like they want to be involved in decisions, but another part feels afraid of taking on responsibility for decisions. Those mixed feelings are very normal at this time. Shared decision-making means that your views are important, but that you do not have to make the decision on your own.
For some cultures, it may be important for other members of the wider family or community to be involved in decisions. When family members are far away and/or cannot travel, it may be possible for them to discuss with the doctors on the telephone.
Types of life support
Life support can be a temporary or permanent measure depending on the situation. In situations where a cure is not possible, life support may prolong the discomfort. In other situations, it is only temporarily used until the body is able to function without assistance.
A treatment with life support may be helpful if it relieves discomfort, restores functioning or enhances the quality of life. But the decision to refuse life support is a personal one and requires discussing the risks and benefits with your health professional.
Some of the commonly used life support treatments are:
- Artificial nutrition and hydration
- Tube feeding (usually inserted into the stomach via the nose)
- Intravenous feeding when tube feeding is not an option
- Cardiopulmonary resuscitation (CPR)
- Comfort care or hospice care
- Mechanical ventilation (often used for pneumonia, lung disease or trauma to the brain)
- Palliative care for those with serious illnesses
The decisions you make are among the most private and difficult moments in life and are usually best in a shared decision-making discussion with all parties concerned. Allowing the health professionals to make decisions with input from the family may be the most compassionate and appropriate approach. Often when a loved one is on life support through a traumatic circumstance like a car accident, the family members may not have had a discussion about the patient’s wishes if they are already on life support and the patient may not be able to communicate if they are seriously injured or ill.
Whatever decision you make when confronted with making the final decision, remember, you don’t have to make that decision alone.