When the body of an ill person with a potentially treatable condition fails to respond to treatment, life support may be temporarily used to stabilize the individual’s condition until the body returns to normal function. In some cases, life support helps bring back the individual to a stable condition and, with further medical help, the body recovers. However, in some cases, the body is not able to return to normal functioning.
Making decisions regarding the use of life support can be difficult for the patient and/or the family. Various forms of life support can help restore breathing, heart function and other bodily functions, and may relieve suffering or even enhance the quality of life. However, these treatments may also be burdensome if they cause pain or discomfort, or prolong the process of dying without apparent benefit. Some may even consider life support unnecessary if it diminishes the quality of life or personal dignity. The decision to maintain or forego life support is a deeply personal matter, but it can be helpful to gather useful information to make informed decisions.
Common Life Support Measures
Cardiopulmonary resuscitation: When a person’s life is threatened by injury or illness, emergency care may be rendered before he/she is able to receive appropriate medical care in a hospital. This basic life support involves cardiopulmonary resuscitation or CPR, which may be administered by trained medical personnel or a lay person. Many lives have been saved by this type of immediate assistance, which can help restore heart function and breathing. However, not many lay people know how to provide CPR, which may come in handy when a life-threatening situation affects someone who is close by. According to the American Heart Association, almost 90% of all cardiac arrests occur at home. Immediate CPR, if performed effectively, can double or triple the chance of survival in a person who experiences a sudden cardiac arrest.
In many cases, advanced life support is used when emergency medical services arrive, or when the involved individual is brought to a hospital. Drugs and electric shock using a defibrillator may be used to restore heart function, while a breathing apparatus may be used to increase or improve the patient’s oxygen intake. While CPR may quickly stabilize the vital signs of a near-drowning victim or a person who has suffered a heart attack, it may not have similar success rates in people who are suffering from a terminal illness. This is why some patients or their families choose not to receive resuscitation when they believe they have no or little chance of recovering from their illness. A terminally ill person who does not wish to receive CPR under some circumstances must inform their doctor, who must write a specific do-not-resuscitate (DNR) order in their medical record. This directs medical personnel and emergency workers not to start CPR should the person suffer a cardiopulmonary arrest.
Mechanical ventilation: This is usually done when a patient is not able to breathe on his/her own and requires a machine (ventilator/respirator) to support or replace lung function. A tube that is inserted into the patient’s windpipe is connected to the ventilator, which assists or controls his breathing for as long as necessary. Although this life support system ensures an adequate supply of oxygen to the patient, it cannot cure his condition, and some terminally ill patients may choose not to receive mechanical ventilation when their bodies fail.
Artificial nutrition and hydration: Tube feeding can help supplement or replace one’s oral caloric and fluid intake by allowing nutrients and fluids to pass through tubes placed directly into the patient’s vein, stomach, or upper intestine. This form of life support may be given until the body heals or until the patient is able to take in nutrients on his/her own. In some patients with serious diseases, tube feeding may be needed long-term. It may improve their condition to a certain extent, in terms of hydration and nourishment, even if it cannot reverse or improve their underlying disease.
Kidney dialysis: When the kidneys fail to function, a special machine may be used to filter excess fluids, salt and wastes from the blood. Although it can restore balance in the composition of the blood, it does not reverse the underlying kidney disease. It may maintain the quality of life of some patients until they can receive a kidney transplant or a more definitive treatment for their disease. However, in other patients, the burden of care associated with dialysis may outweigh its benefits.
Terminally ill patients must discuss end-of-life issues with their families and their physicians. They can work with their families and health care providers to decide whether or not they want to receive life support, especially if these measures will prolong their suffering and offer no beneficial effect. Sometimes it is difficult to decide whether to start treatments or not, and whether or not to terminate life support. In any case, withholding or withdrawing medical treatment according to a patient’s wishes is legally and ethically acceptable. It is also important to understand that it is the underlying disease, and not the withdrawal of treatment, that ultimately results in death.
Here are some resources to help you understand more about life support measures and their ethical implications.
Understanding Life Support Measures
Cardiopulmonary Resuscitation (CPR)
Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest
What Is an Automated External Defibrillator?
What Is an Implantable Cardioverter Defibrillator?
Artificial Nutrition and Hydration
Pulling the plug: ICU ‘culture’ key to life or death decision
When is the Right Time to Turn off Life Support?
Myths and Facts About Health Care Advance Directives
Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy
Artificial Nutrition and Hydration: Clinical Issues