Even though we talked about it, I don’t know if I can make a “life or death decision” for my husband.Would it be so terrible just to let nature take its course?

96. Even though we talked about it, I don’t
know if I can make a “life or death decision”
for my husband.Would it be so terrible just
to let nature take its course?

Remember, by stopping life-sustaining treatment,
you are not killing the patient.
The cancer and/or underlying medical condition is
what causes the person’s death.

Surrogate decision makers who agree to a DNR order
and/or to stop life-sustaining medical intervention
may feel guilt or that they are “giving up,” even though
they are acting according to the patient’s previously
stated wishes and/or in the best interests of the
patient. Other difficult decisions for surrogates include
asking for more pain medication for dying patients
with extremely advanced disease, since the amount of
medication required to alleviate their symptoms can
make them less alert and, in rare circumstances, hasten
a person’s death by a short amount of time. This can be
extremely distressing to the people making medical
decisions for their loved ones.

People who do not react well to a crisis may respond in
two basic ways. One is to make rash decisions based on
blind emotion rather that reasoned thought. The other is
to wait and do nothing, which is often the result of
“paralysis by analysis.” The latter choice is more common
and may seem reasonable given what we have previously
said about collecting as much information as possible in
order to make an informed decision. However, by waiting,
you may be prolonging the patient’s status in a state
of indignity. Furthermore, prolonging treatment for a
patient who previously stated that she did not want to be
treated or be on life support in this condition is not ethical.

If you come to an impasse, try to limit yourself timewise:

Ask the doctors how long you have to make the
decision, and if it seems reasonable, try to stick to it.Talk
to involved family members and others whom you think
can help you make the best decision.

For some people, the underlying issues are that they just
do not want the responsibility and/or they simply cannot
bear to let go of their loved one emotionally.

Remember that your decision as a proxy needs to be
based on the patient’s preferences as you best understand
them. If these preferences are not clear in your
mind, then speak with other people who might have
insight into them: friends, family, and the doctors.

Patients will often have a discussion of this sort with the
medical team when family isn’t present precisely because
they don’t wish to upset them. Many oncology professionals
have had in-depth conversations with patients
about their wishes regarding life-sustaining treatment
and have helped patients relate these wishes to their surrogate.

If you do agree to a DNR order or an increase in
a medication dosage, you probably won’t be asked to
sign anything. This is because these orders come from
the physician, not from you. It is they who are directing
the course of care, and thus sharing the responsibility
for any decision with you. If you have concerns or questions
about end-of-life care issues, speak with the physician.

Furthermore, ethics consultants, patient advocates,
or social workers are available for extra guidance. If the
situation reaches an impasse, all hospitals are required to
have an ethics committee where you, the doctors, and
other involved people can meet to discuss solutions.

Remember, by stopping life-sustaining treatment, you
are not killing the patient. The cancer and/or underlying
medical condition is what causes the person’s death.