If a loved one has chosen you to act as their health care agent, you need to learn all you can about the decisions you may be called upon to make. First, discuss in detail with the person the choices she would make for herself. Make sure these are put in writing (for example, a living will). Next, familiarize yourself with terms that may come up. Make sure everyone involved in the process understands words or phrases in the same way.

I still remember the concern I felt in nursing school when some in the class expressed their support for euthanasia for patients whose lives were “burdensome, not worth living, or too costly to prolong.” The word euthanasia is derived from the Greek eu ‘well’ + thanatos ‘death’ (literally the “good death”). Active euthanasiais the intentional killing of a patient (usually by lethal injection) by the direct intervention of a physician or another party, supposedly because that is what is best for the patient and what he desires. Passive euthanasiais the act or the omission of an act that by intent or consequence results in death. Some have made the distinction between active and passive euthanasia as “killing” and “letting death occur.” Some believe that there is no distinction and either of these choices is iniquitous and that every available medical intervention should be utilized to prolong life. These are grave moral decisions for anyone charged with making them.

Unequivocally, I believe that active euthanasia or physician-assisted suicide (the doctor provides the patient with the means to take his own life) is terribly wrong. However, I also question the practice of extensive life-prolonging medical measures, especially when the patient has a fatal illness and is approaching a natural death and the condition cannot be reversed.

As a nurse in long-term care, I realized many family members misunderstood the definition of a Do Not Resuscitate(DNR) order. Often, they thought it meant their loved one would be “left to die” and this is incorrect. Actually, the term is self-explanatory – you cannot resuscitate someone unless his or her breathing or circulation has stopped. In other words, a DNR order means that medical personnel will not attempt to bring someone back to life, not let them die. While cardiopulmonary resuscitation (CPR) can be used effectively in an emergency situation (such as after an accident or sudden cardiac arrest in an otherwise healthy person), patients who are compromised, frail or elderly usually do not respond well and injuries such as broken ribs or collapsed lungs can result.

When a patient is no longer able to swallow or digest food and liquids normally, medically assisted nutrition and hydrationare sometimes provided. This is usually through a tube inserted into the stomach – feeding tube, G (gastric) tube, or PEG (percutaneous endoscopic gastrostomy) tube. Nutrition and hydration can also be provided intravenously (IV) or through a tube inserted through the nose – a NG (nasogastric) tube. While these interventions are effectively used for short-term intervention when recovery is possible, sometimes family members request them for a loved one who would otherwise die, believing that refusing to do so would be “starving the patient to death.” When someone is dying, the body “shuts down” and nourishment is no longer needed. Force-feeding can do more harm than good.

This article has barely touched the surface of this critical subject, and may have raised more questions than it has answered. That is why it is so important for health care agents to explore all options with their loved one before the time comes when the decision can not wait. Talk. Seek input from medical professionals. Do your own research. Pray for wisdom. Make the choices your loved one would make.

Caring quote: “Even if one family member is named as the decision-maker, it is a good idea, as much as possible, to have family agreement about the care plan.” – National Institute on Aging