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End Of Life Care


Personal Representation Agreements name a substitute decision maker. You may be named for your spouse, parents or other loved ones. Thus, you are the person who must instruct medical staff when the person, near the end of their life, can no longer medically able to do so. You may only have a partial picture of the decisions you could face in these circumstances. Perhaps you have thought of having to say, turn off the life sustaining machines if an MRI scan shows there is no hope of recovery from brain trauma. What about other instances we take as ordinary but become extraordinary?? It could be decisions on blood transfusions,intravenous feeding for those unable to swallow or maybe dialysis procedures. Answers on what exactly to do will vary in many households and arguments could result.

End of Life Care can best be explored early with the substitute decision maker and with family and friends. Almost everyone will say they do not want to be kept artificially alive and want no heroic measures taken, but this is only a vague notion. What does that mean, exactly?? Vague terminology can be interpreted differently by family and even by Doctors. If this is not explored further into an actual medical plan, then you are left to work with a vague notion, and that is a problem.

Working through potential scenarios and overall goals of care should help respect the wishes of patients who can no longer voice them. It can also help you or the family members with the agonizing decisions and alleviate some stress and anxiety. Of course these situations are not easy, but if you have conversed with the person previously, it sure helps. There is more detailed information in this area at

One of the first steps is to spend time figuring out what makes life meaningful for the person in question. That might be:

  1. Being able to recognize my family;
  2. Being able to have conversations;
  3. Being able to remain physically active;
  4. Being able to work in their garden;
  5. Being able to play guitar or whatever other activity.

The question might be: “What would make it unacceptable-or –acceptable to prolong my life, if I were in a coma and there was little chance that I was going to have the quality of life that is important to me ?” Some want to fight death at all costs with all medical tools available. But many others will decide that if, for example, Alzheimer’s disease turns family and friends into strangers – that they would rather have comfort care to ease the dying process, should they become sick from a virus or pneumonia, rather than seek an unlikely cure.

The ultimate goal in considering end of life, is to be as prepared as possible for making choices that reflect a person’s values and wishes. It does not tell you everything to do, but allows you to be ready.

If you are named as a decision maker for someone, encourage them to discuss with you, their wishes and what they would like under various situations that they may face in future with their health.

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