About Health Care
Making Medical Decisions
It is often hard to make medical decisions, especially ones that involve end-of-life care. Many people say they do not want to die slowly, hooked up to machines or fed artificially through tubes, but how do you know when care will only prolong death, or whether care will restore the patient to life?
To understand a current condition and need for tests, ask the health care provider:
- What is the name of the condition?
- What is the condition doing to the patient now?
- If you don’t know exactly what’s wrong, what are the possibilities?
- Are tests needed to know more?
- Will the outcome of more testing make any difference in how you treat the condition, or in how the patient would want to be treated? (If not, why do a test?)
- What is the purpose of each test? Do these tests have risks associated with them?
- Is the information you need worth the burdens of the test?
To understand the prognosis, ask:
- What is the usual course of this disease or condition?
- Is there a reason to think the patient’s disease course will be different?
- How severe or advanced is the condition in this case?
- Would you be surprised if the patient were to die in 6 months? One year? Two years? Five years?
To evaluate proposed treatment, including end-of-life care, ask:
- In the event of a crisis, what is the chance that treatment (for example with a ventilator, chemotherapy, or CPR) be effective in prolonging life? For how long might life be prolonged?
- What is the success rate?
- Would treatment be effective in restoring, improving, or maintaining function?
- How would you define success for this treatment?
- Is treatment likely to increase or decrease pain or other distressing side effects? Will the patient feel better?
- Are there psychologically harmful side effects?
- Will treatment impair social interaction?
- Might the patient benefit from a time limited trial on life sustaining treatment?
- What conditions might cause you to recommend that treatment be stopped or not started?
- Can this procedure be done on a trial basis and then reevaluated?
- What is an appropriate amount of time for a trial? Are you willing to stop it after an agreed-upon trial?
- If life sustaining treatments are used, how will you maximize and maintain comfort?
- How might the treatment affect the circumstances of death? (For example, will it likely require hospitalization instead of home care?)
- What option do you recommend, and why?
Adapted from Utah Commission on Aging Tool Kit for Advance Healthcare Planning (2012) and Making Health Care Decisions for Others, from the Division of Bioethics, Montefiore Medical Center, Albert Einstein College of Medicine.