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Making Decisions

New Decisions

Changes in your medical status are common in the hospital and new health care decisions often need to be made. Most medical decisions will be discussed with you, or your health care agent if you are unable to make decisions on your own. However, based on the urgency of the situation, the medical team may have to make some decisions on its own.

Every individual approaches decisions differently. If it makes you more comfortable, include your family or friends in the discussions with the medical team. Make sure your health care agent is present or informed of any decisions.

To make decisions, you will need clear information about your situation and an understanding of your options. You can begin by asking your medical team these questions:

  • How urgent is the decision?
  • How much time do I have to decide?
  • Who can help me make this decision?
  • Will this procedure/treatment cure or improve my illness?
  • Will this procedure/treatment improve my symptoms (make me feel better)?
  • Will this procedure/treatment improve my function (for example, ability to work, talk, dress)?
  • Will this procedure/treatment extend my life?
  • Will this procedure/treatment allow me to go home?
  • Is this procedure/treatment covered by my insurance?
  • Will this procedure/treatment require changes to my lifestyle?
  • Will the outcome of this procedure change my plan of treatment?

Difficult Decisions

If an individual is in critical condition, some decisions may be focused on life-sustaining treatments (for example, CPR, feeding tubes, dialysis, or artificial breathing machines). Learn about life-sustaining treatments.

Unless told otherwise, medical staff in the hospital will do CPR on all patients whose heart or lungs stop functioning. If you have a high risk of failure of breathing or cardiac (heart) failure, the medical team may ask about your choices regarding CPR and if you would consent to a Do Not Resuscitate (a “DNR”) order.

With a serious illness, CPR may not improve a person’s symptoms or life expectancy and may actually cause suffering. Before you make any decision regarding a DNR you can discuss with the physician what the likely effect would be if CPR were performed on you. If you have a DNR in place, you will still get all medical care and support. It means only that aggressive measures of intubation or chest compressions will not be performed if you stop breathing and have no pulse.

Depending on the situation, you may have already made decisions about life-sustaining measures and have documented them in your advance directives (health care proxy, MOLST, or in a conversation). If this is a new discussion, it is important to understand the advantages and disadvantages of these interventions based on your circumstances.

Make sure the medical team explains about a proposed life-sustaining treatment, including:

  • Devices or machines used and any discomfort they may cause
  • Expected outcome – improvement of functions, quality of life, life extension
  • Alternative choices of care

If faced with a difficult decision, often the health care agent and family members need a meeting with the medical team (a “family meeting”) to discuss the situation and get additional information and support. A family meeting can help everyone “get on the same page” about what is going on, what to expect, and where the focus of care should be going forward. It is important to understand all options for care – now and in the future.

It can be helpful to ask your physician for a consultation with the hospital’s palliative medicine services. Assistance with medical decisions is one of its areas of expertise.

In addition to doctors and nurses, other services in the hospital (for example, chaplaincy, social work, health advocacy) can offer support and assistance. Feel free to ask for them.