Some of the toughest decisions in health care involve the end-of-life experience, death, and dying. How should healthcare professionals make those decisions?

How do we decide when enough is enough in terms of our life support efforts for patients, and who should help us to make such important decisions?

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RE: Discussion Board Question

When a patient's family and the doctors and nurses taking care of him decide to discontinue organ support (the correct term for stopping machines and medications that help the body's organs function when they are too sick to perform on their own),they always prescribe medications that provide comfort and relief of pain, distress, difficulty breathing, and other symptoms that can come up during a natural dying process.

Some doctors predict time of death scientifically by

1. Disease Nature - Comparing a patients condition with published data. For example, on an average a stage 4 pancreatic cancer patient survives for 3 and a half months. In contrast some kind of cancers like 'Hodgkins disease' are fully curable with 5 year survival exceeding 95%. This kind of data is generated over years of study with hundreds of patients. We interpolate this data to a given patient, which may be wrong in many cases.

2. Clinical Signs of imminent death like gasping breathing, feeble pulse, low blood pressure, low oxygen content of blood (measured by a pulse oximeter), altered sensorium, delirium etc indicates bad outcome in a short time.

3. Mental state - patients suffering from chronic disease like a widespread cancer or chronic Heart failure often suddenly 'give up'. They tell us 'doctor I don't think I will recover this time.' Such negative predicament and feeling of doom is often correct.

Who helps makes the decision of the patients life? We have long accepted the role of people who treat the patient not their decision makers. Thus we need consent before making any major decisions. Hence decisions like withholding life saving measures are only taken after getting a proper consent of the family and in its absence preservation of life at all cost is assumed and strictly followed.