End of life care encompasses all of the spiritual, physical, and psychosocial care you receive at the end of your life. With end of life care the goal will be to help you live as comfortably as possible until you die and to support a dignified death. Interventions can include palliative care, supportive care, and hospice care among other things. End of life care is applicable within the last year or months of life, but often this is difficult to predict.
As with palliative care, it is important to speak with your healthcare provider and your loved ones about your wishes at the end of life. It is also important that these wishes are recorded legally and in a complete document. Explore the Advanced Care Planning page to learn more.
Options at the end of life
There are various options to consider at the end of your life. These options can vary depending on where you are living and provincial laws and regulations. Talk with your family doctor and specialists about the options at the end of your life. These options may include:
- Palliative care
- Do not resuscitate orders (DNR)
- Refusal or withdrawal of treatment
- Refusal of food and drink
- Palliative sedation
- Medical assistance in dying (MAID)
Do not resuscitate (DNR)
You may have the option of completing a ‘do not resuscitate’ order, commonly known as DNR. This is a signed document that will let medical professionals know (doctors, nurses, paramedics, etc.) that they are not to perform cardiopulmonary resuscitation (CPR) on you in any circumstances.
Refusal or withdrawal of treatment
You have the legal right to refuse any medical treatment, even if it could save your life. If you are already receiving a treatment, you can decide at any time to have some or all of the treatment stopped. There are some factors medical professionals have to consider in these instances, such as being sure you are in an appropriate state of mind to make this decision and have been fully informed of the risks and benefits of receiving or not receiving the treatment.
Refusal of food and drink
Receiving nutrition and hydration via a tube is considered a medical intervention. Therefore, you have the legal right to refuse food or drink and discontinue this treatment.
This is typically one of the last options when other treatments are not relieving your symptoms. In this situation, medications are given to ensure that you are comfortable while you live out the last moments of your life. The medications that are given will not hasten or cause death but they can be changed based on the desired effect. Some patients only need an amount to keep them calm while others need a higher dose to keep them comfortable in a deep sleep. Often times, these effects can be reversed by medical practitioners to wake you up so you can communicate with your loved ones. Talk to your healthcare team and loved ones about palliative sedation.
Medical Assistance in Dying (MAID)
Medical assistance in dying is a relatively new option available for patients living with life threatening illnesses. There are certain requirements for patients to be eligible, which is set out by a federal law. Talk with your healthcare provider about MAID. In this circumstance, a medical professional will prescribe and administer medicine that will bring about your death. For more information visit MAID for resources and contact information.
To make decisions about the above-mentioned options, and any options throughout your healthcare journey there are two major things that will be considered by your healthcare team.
This ensures that as a patient you have received information about the nature of your illness, the purpose of a proposed treatment, alternatives to the treatment and the risks and benefits of not receiving or receiving the treatment. IN addition, the healthcare provider must be sure that you are consenting voluntarily with no outside influences and have the capacity to consent (discussed below)
Capacity to Consent
This is determined by the healthcare provider prescribing and administering a treatment. They must be sure that you understand all the necessary information about a treatment so that you can make a decision and that you understand the consequences and risks of your decision. In some cases, you can have the capacity to make a decision about one aspect of your healthcare (like what to eat) but not another (like an operation). If a healthcare provider finds that you do not have the capacity to consent they must seek consent from a legal guardian, substitute decision maker or ‘agent’ as if often defined in advanced care planning procedures.
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