To say there is some confusion among authors as to what constitutes lifesaving measures really should not be a surprise. After all, most people not involved in medicine can have a difficult time with the concept.
Lifesaving measures is a broad term. It can be used to describe any futile care to a patient that is likely not to live. However, often times these same lifesaving measures are really a bridge to get a patient through a critical illness that they can fully recover from and still lead a long life but will certainly die if they are withheld.
What you should do is examine each of these areas and think through the possibilities of what situations you would be okay receiving these and which you wouldn’t and make that decision clear to your family.
So– what are some of these lifesaving measures.
1. CPR: This is chest compressions. Generally, when people are a DNR (Do Not Resusitate), this is its basic definition. If your heart stops and you’re a DNR– we won’t do compressions. You can delineate this further by also saying I don’t want drugs or electricity. Some patients are fine getting the medications but they don’t want their chest to be pounded on. However, CPR is the one mechanism that will MOST LIKELY bring you back in conjunction with these other therapies.
2. A ventilator: This is a breathing machine where a tube is inserted into your mouth, through your vocal cords, and into your trachea to assist with breathing. Being on a ventilator is hard. It is not anything like the natural way we breathe. A patient can say– I don’t want to be intubated. However, this can also be short term. Say a healthy, young male has a severe pneumonia. He’s just not able to maintain his oxygen levels and his breathing worsens. In most circumstances– as a nurse– I would not expect the patient to die but he NEEDS that breathing machine to buy him some time for the antibiotics to kick in…etc.
3. Vasopressors: These are drugs that help support blood pressure. Many shock states will cause lower blood pressure which is bad. You need normal blood pressure to heal. This is another area that might be short-term to buy the patient the time they need to get better.
4. Nutrition: I’m going to lump this all into one category. It can include everything from IV fluids, to TPN (which is IV nutrition) to a feeding tube. If this is withheld, what you die from is dehydration and starvation. This is what the Terry Schiavo case centered on. Some people believe withholding food and fluid is unethical as it is a basic requirement to live. How about you?
5. Oxygen: You can get oxygen many ways without being on a ventilator. Through nasal prongs, through a mask, and sometimes via a machine called CPAP or BiPAP. Again, this may be a short term measure to help a patient through an illness and most often is used for that very reason. But, if you take them of their oxygen– they will die.
Patients and families need to be well-educated in what these terms actually mean well before they are sick enough to be forced to make a decision during a crisis.
Lifesaving measures and End-of-Life Care are not really interchangeable. Have these conversations with your family now.
What about you? What would you want and not want? Under what kind of circumstance?