Does one or more of these situations sound familiar?
- Mrs. J has suffered a severe stroke and has been in the hospital for two weeks, living with the support of a ventilator. She can't speak for herself and left no official document spelling out her wishes. Mr. J (her husband) has been told that things don't look good and its unlikely Mrs. J will be able to ever go home. He doesn't know what to do.
- Mr. R has been living in a nursing home for a year, but was recently admitted to the hospital because of a bowel obstruction. The doctors say the only way to fix the obstruction is through surgery. Mr. R is not clear-headed, but in the past has said "no more surgeries." His two children are arguing about whether Mr. R should have the surgery.
- Ms. N has had many health problems in the past, was recently diagnosed with lung cancer and is back in the hospital because of a urinary tract infection. Ms. N is clear-headed and knows what she wants. But she's unsure what to decide about treatment for the lung cancer. And she wants to make sure that her wishes are honored if she becomes unable to speak for herself.
These situations, and others like them, call for making and carrying out appropriate care decisions.
Making care decisions: Making appropriate care decisions requires asking questions and getting answers, developing and adjusting care and treatment plans and goals, selecting places for care, and following through.
Things you need to know: You need to know about the person's current health situation, treatment options (including their benefits, burdens and risks), and the likely outcomes.
Selecting goals of care: The goals of care you select will depend on the circumstances, and goals often change when the circumstances change. Based on the goals you select, different treatment choices will be appropriate.
Goals of care include curing the illness, or stopping or slowing down its progress; maintaining or improving function; prolonging life; being clear-headed or in control; allowing a natural death; and relieving pain and suffering.
Who you can talk to: To get information about the health situation, treatment options and likely outcomes, designate a "quarterback" doctor and speak with him or her. The nurses can also help you obtain the information you need.
Deciding about care for another person
When you are making decisions about care for another person, your duty is to follow his or her wishes (whether expressed in a legal document or just in conversation). If you don't know the wishes, you must follow his or her values and views about life. If you still don't have enough information, you must act in his or her best interests.
You don' t have to make decisions alone. Discussions among family and friends can be very valuable. Ask for help from your doctor, or a nurse, social worker or spiritual care advisor.
More Resources: Ask a TMMC nurse, social worker or spiritual care advisor about:
- Obtaining the booklet Hard Choices for Loving People
- Arranging a care conference to obtain more information and to help make appropriate care decisions
- Requesting language translation services
- Requesting a palliative care consultation
- Obtaining the pamphletThe Role of the Ethics Committee
- Creating an advance directive or health care power of attorney