Advance Care Planning: Should I Stop Treatment That Prolongs My Life?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Advance Care Planning: Should I Stop Treatment That Prolongs My Life?
Get the facts
- Stop treatment that prolongs your life. Instead, receive only treatment that focuses on your comfort and quality of life.
- Don't stop treatment that prolongs your life.
Key points to remember
- If there is a good chance that your illness can be cured or managed, your doctor may advise you to first try available treatments. If these don't work, then you might think about stopping treatment.
- If you stop treatment, you will still receive care that focuses on pain relief, comfort, and the quality of your life. This is called hospice care.
- A decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind if your health starts to improve.
- Even though treatment focuses on helping you live longer, it may cause side effects that can greatly affect your quality of life and your ability to spend time with your family and friends.
- If you still have personal goals that you want to pursue, you may want treatment that keeps you alive long enough to achieve them.
There are several kinds of treatment that can help you live longer. These may be needed for only a short time until your illness improves. Or you may use them over the long term to help keep you alive.
Some treatments include the use of:
- Medicines to slow the progress of certain diseases, such as heart disease, diabetes, cancer, AIDS, or Alzheimer's disease.
- Antibiotics to treat serious infections, such as pneumonia.
- Dialysis to clean your blood if your kidneys stop working.
- A breathing machine to help you breathe if you can't breathe on your own. This machine pumps air into your lungs through a tube inserted into your throat.
- A feeding tube or an intravenous (IV) line to provide food and fluids if you can't eat or drink.
- Cardiopulmonary resuscitation (CPR) to try to restart your heart.
The decision to receive treatments that may help you live longer is a personal one. You may want your doctor to do everything possible to keep you alive, even when your chance for recovery is small.
Or you may choose hospice care, which focuses more on how well you live rather than how long you live. It looks for ways to make you more comfortable, such as helping to manage your pain and other symptoms.
These can be tough decisions to make, but you don't have to make them alone. Look to your family, your doctor, your spiritual advisor, and your friends for help and support.
Palliative care is a kind of care for people who have serious illnesses. It focuses on relieving pain and other symptoms and improving your quality of life—not just in your body but also in your mind and spirit.
The kind of care you get depends on what you need. Your goals and values guide your care. You can still get treatment for your illness at the same time as you get palliative care to help with the side effects of treatment. But there may come a time when you decide that palliative care is more important.
If you choose to stop treatment, your doctor, nurses, and others who provide palliative care will focus on easing your symptoms and providing emotional and spiritual support for you and your family. They can help you and your loved ones:
- Better understand your illness.
- Talk more openly about your feelings.
- Decide what treatment you want or don't want.
- Plan for the future.
They can also make sure that the rest of your health care team and your family and friends understand your goals and respect your wishes.
When you, your loved ones, or your doctors feel that you only have a short time left to live, you may want to think about hospice care. Hospice provides palliative care for people who are in their final weeks or months of life. Hospice services include managing pain and other symptoms and keeping you as comfortable as possible in a familiar environment with your family and friends. Hospice programs also provide services to support the needs of your family, friends, and other caregivers.
Some people may worry that if they stop treatment, they won't get the best care. If you choose to focus only on palliative or hospice care, you will still have access to doctors and excellent care. A decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind if your health starts to improve.
You might consider treating your illness if:
- There is a good chance that it can be cured or managed.
- You think you can manage the possible side effects of treatment.
- You don't think treatment will get in the way of your quality of life.
- You have personal goals that you still want to pursue and achieve.
You might ask yourself what kinds of treatments you may want if:
- You have a serious illness that can't be cured.
- You slip into a coma and there is little chance that you'll come out of it.
- You have a long-term illness that gets worse over time, with no chance of getting better or being cured.
You might think about what your doctor says about your chances for recovery and how that might affect what you decide to do.
Even though medical treatments may help to prolong your life, they may also cause pain and other side effects that can greatly affect your quality of life and your ability to spend time with your family and friends.
You might also ask yourself what "quality of life" means to you and how much control you want to have over it.
- Do you want to be able to function and live on your own?
- Are you okay with living in a hospital or nursing home?
- Are you okay with being kept alive by machines?
It can be hard to decide when to stop treatment. But there are some questions you can ask your doctor to help make things more clear, such as:
- Is it possible to cure my illness? Some health problems can be cured or managed successfully for many years with available treatments. Other illnesses get worse quickly and can't be cured.
- What are my treatment options? Many treatments can cure or treat an illness with little effect on your quality of life. But some treatments may cause side effects that can greatly lower your quality of life.
- How long do you think I have left to live? It may be hard for your doctor to know when your life will end. But he or she may be able to estimate how much time you might have left, based on how well you respond to treatment and how much your illness has progressed.
If you don't already have an advance directive, this may be a good time for you to prepare one. An advance directive is a legal document that describes the kinds of medical care you want to receive and how you want your health care wishes carried out if you're near the end of your life or are in a hospital with a serious illness. It tells your family and your doctor what to do if you can't speak for yourself.
Your doctor may suggest that you stop treatment that prolongs your life if:
- Your chance of surviving your illness is very low.
- You have tried all possible treatments for your illness, but they haven't helped.
- You can no longer deal with the side effects of treatment.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You receive treatment that focuses on managing your symptoms and quality of life instead of curing or slowing the progression of your illness.
- You avoid the side effects of treatment.
- You can focus on being comfortable, spending time with your family and friends, and making any arrangements that you need to make.
- You may die sooner.
- You may not be able to pursue or achieve your personal goals before you die.
- You receive treatment that may cure or slow the progression of your illness.
- You may live longer or, in rare cases, be cured of your illness.
- You may be able to pursue and achieve your personal goals.
- Treatment may cause side effects that may affect your quality of life and your ability to spend time with your family and friends.
- Treatment may stop working, so you may not get better.
Personal stories about care options at the end of life
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
When I was recently diagnosed with cancer of the lung, my doctor discussed treatment options with me and my family. The tumor in my lung cannot be surgically removed. Chemotherapy may prolong my life somewhat, but I don't want to risk the side effects associated with these medicines. I have lived a long, full life and I want to die comfortably at home with my family. I want to remain active as long as possible. I am willing to allow hospice to help my family care for me when I need additional help.
Tully, age 83
About a year ago I was diagnosed with acute leukemia. I went into remission shortly after I started chemotherapy. Unfortunately, this remission was only brief, and I am back on chemotherapy and radiation therapy. I have small children at home and want to see them grow. My doctor has informed me that I may need to try other forms of treatment, such as a bone marrow transplant. I am willing to pursue treatment that may cure my illness. If I develop complications, I want to receive any treatment that would keep me alive. I am not ready to give up.
Mia, age 32
I have had AIDS for 3 years. I have taken many medicines, but I am now getting frequent infections that do not respond to the medicines. I have spoken to my partner, family, friends, and doctor and do not want to receive CPR or be placed on a ventilator if I stop breathing. I don't feel comfortable dying at home, because I am concerned about the welfare of my partner. I have chosen to live at my home as long as I possibly can, then move to a hospice house in my hometown. This way, a hospice team can help manage my symptoms, and my partner and other family members can participate in my care.
Marion, age 39
I was just 33 when I had my first heart attack. My heart disease has progressed in spite of medicines, bypass surgery, and lifestyle changes. Other than my heart disease, I'm pretty healthy. My remaining treatment option is a heart transplant. Without this, I am likely to die. Even after the heart transplant, I will need to take a lot of medicines, continue my healthy lifestyle, and see my doctor often. I live a productive life and am willing to have a heart transplant if it will prolong my life.
Javier, age 54
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to stop treatment that prolongs life
Reasons not to stop treatment
I'm ready to face my death and let my illness take its natural course.
I want to try every possible treatment to stay alive, even if there is little chance that I might survive.
I've already met the goals I set out to achieve in my life.
I still have personal goals I want to pursue and achieve.
The side effects from my treatment are making me feel worse.
I feel better than I did before I started treatment.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT stopping treatment
What else do you need to make your decision?
Check the facts
When you stop treatment, does it mean that you stop receiving care?
- YesSorry, that's not right. If you stop treatment, you will still receive care that focuses on pain relief, comfort, and your quality of life.
- NoThat's right. If you stop treatment, you will still receive care that focuses on pain relief, comfort, and your quality of life.
- I'm not sureIt may help to go back and read "Get the Facts." If you stop treatment, you will still receive care that focuses on pain relief, comfort, and your quality of life.
Can you receive treatment again even though you decided to stop?
- YesThat's right. A decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind if your health starts to improve.
- NoSorry, that's not right. A decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind if your health starts to improve.
- I'm not sureIt may help to go back and read "Get the Facts." A decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind if your health starts to improve.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Shelly R. Garone, MD, FACP - Palliative Medicine|