Decision Making
When is the right time to discontinue life support?

Discontinuing life support is one of the most difficult and complex decisions a family can make. It may help to go through these steps in making your decision:

  1. Learn as much as you can about the medical situation and the likelihood of improvement.
  2. If your loved one prepared a health care directive, then use this to guide care decisions. If the directive names someone to act as a proxy, then the proxy decides on care.
  3. Imagine what your loved one would say about the situation if he or she were able.
  4. Ask health care providers or a hospital ethics committee for guidance.
  5. Have the health care team monitor the situation and assess, or reassess the situation.

1. The first step is to get as much information as possible from the health care team about the possibility of recovery. If recovery is possible, it’s important to understand to what degree it’s possible and what level of functioning the patient will have. Lung functioning is important, but brain functioning is usually the main consideration. If the brain is not expected to recover to the point of allowing awareness of self and surroundings, then the quality of the person’s life must be seriously examined. Quality of life is a major factor in making a decision about life support.

2. Once you have a good sense of what can be expected medically, you may find guidance in a health care directive. Ideally the patient will have prepared such a document, and it addresses this scenario and what to do. Alternatively, it names a person to act as a proxy in order to make decisions on the patient’s behalf. Unfortunately, most people have not prepared such a document, or if they have, it’s too vague to offer clear direction.

3. If there is no health care directive, or if the directive isn’t clear on this situation, then ask yourself what the patient would want. Families struggling with decision-making may find that role-playing is a way to come to a decision that feels right. First, imagine the patient is alert. Then, imagine explaining all the available options. Now, ask yourself, “What would he or she likely say?” When family members think of this, very often they’re clear what their loved one would say. It might be “I don’t want anything to prolong this condition" or, “Take me off the machine." It might be “I want all possible treatments that make sense medically.” It might be something else. If you’re confident that you know what your loved one would say, then you have the most helpful possible piece of information to guide decisions. In this case, you’re not making the decision, rather, you’re conveying the patient’s wishes.

4. If you’re not sure what the person would say, you can ask for guidance from health care providers. Some hospitals have an ethics committee that can help with these difficult issues. The ethics committee meets with the health care team and the family to discuss the situation. It then provides guidance on what decisions are ethically acceptable.

5. There may come a time when the health care team no longer considers it good health care to continue life support. Their treatment efforts may be intense, yet they see no improvement in the patient’s condition, and don’t expect improvement. If the situation reaches this point, it’s time for a reassessment and serious discussion with the health care team, the patient if possible, and family.

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