Cancer Diagnosis - Important Decisions to Be Made in the Dying Process
There are many important decisions to be made when a person is diagnosed with a terminal illness, including the following:
- Right to refuse treatment
The patient and family have the right to refuse treatment. Often options for treatment are offered that may extend life, but not provide a cure. The quality of life should be considered as well as the possibility of extending it.
- Decision to die in the home versus hospital setting
Many families want their loved ones to die at home in their natural and most comfortable setting. Others do not feel they can emotionally handle the death in their home. Include all family members in this important decision. Not all decisions have to be made at once, and they can be reversed. In some cases, families think they want to be at home and then find the hospital to be more comfortable, whereas some families choose to be in the hospital and then find that they and the patient are more comfortable at home. Time and circumstances can help to make these decisions. Ask as many questions as possible to obtain the information needed to make the best decision for your family.
- Advance directives, if age appropriate (18 or older)
Adults, 18 years of age or older, can prepare an advance directive. Advance directives are documents that are used only if a person loses capacity to make decisions or suffers an injury or disease that renders them unable to communicate their wishes. Persons under age 18 may prepare an advance directive. However, by law (in most circumstances), parents or healthcare providers are not required to honor it.
- Do not resuscitate (DNR) order
A do not resuscitate (DNR) order is a formal request by a person or a person's family to not take extreme measures to save his/her life. A DNR order is usually reserved for a person near death or with a terminal illness that, even if resuscitated, would not have a high quality of life or a long period before death would occur despite resuscitative efforts. DNR orders can specify how much intervention is desired prior to death (i.e., no use of cardiac drugs, no oxygen, no chest compressions, etc.). These need to be discussed and written by a physician. A DNR is also needed for home.
- Autopsy decisions
An autopsy is an examination of the organs and/or tissues of the body after death. An autopsy is often used to determine the cause of death, but may also be done to research the fatal disease for future diagnosis, treatment, and prevention strategies. The decision to have an autopsy is a very personal choice and should be decided upon when the family is ready. Often an autopsy may help the family with closure. In a patient with a rare disease or cancer, or a condition that has a genetic cause, an autopsy can provide important information for other family members. If genetic testing has not already been done, or is not available at the time, DNA banking may provide an option of testing in the future.
- Organ donation, if possible
Laws governing organ donation vary slightly from state to state. Your healthcare provider will be able to inform you of these options.
- Palliative/hospice care
Palliative care is care aimed at comfort versus cure and treatment. Hospice is a type of palliative care that provides services to improve the quality of life for the family and patient, stressing peace, comfort, and dignity.
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