End of Life Care
End-of-life care is the medical care and treatment a person receives near the end of their life or when they reach the advanced stages of a terminal illness. End-of-life care provides physical comfort, supports practical tasks, and meets the person’s mental, emotional and spiritual needs.
What Is End-of-Life Care?
End-of-life care is the support and medical care provided to someone nearing their natural death. If a person has a chronic or terminal illness, end-of-life care may last days, weeks or even months.
It is a smart idea to make many of these decisions early during the retirement planning process rather than waiting until they are needed to be made under duress.
People may have choices in determining where to receive end-of-life care. It may take place in a hospital or other medical facility, or they may choose to receive end-of-life care in their home.
- Mental and Emotional Needs
- A counselor trained or experienced in end-of-life issues can help a patient with emotional pain and suffering. People in end-of-life care — especially those alert near the end of life — may deal with depression, anxiety and other emotional, mental or behavioral issues. Providing physical contact, communicating directly with the dying person, and setting a comforting mood can help with emotional and mental needs.
- Physical Comfort
- A wide variety of physical discomfort may happen during the dying process. Medical providers can provide different treatments to ease pain, breathing issues, skin irritation, digestive issues, fatigue and temperature sensitivity.
- Practical Tasks
- People who are dying may worry about how things in their life will go on without them. Reassuring them that someone will be there to water their plants or care for their pet can reassure them that their personal affairs will be taken care of. Offering to take care of a caregiver’s practical tasks while they are consumed with end-of-life care for the dying person can also help ease the burden on the caregiver.
- Spiritual Needs
- The dying person may find comfort in finding meaning in their life, ending old disagreements with friends or family, or taking comfort in their faith. If the person is religious, talking to a member of their clergy can provide solace. Talking with friends and family — even long distance — can also bring a sense of spiritual peace.
Making plans when you are healthy for how you wish to receive end-of-life care can make the decision easier on you and your loved ones when you need it later in life.
Types of Care and Treatment
End-of-life care may involve palliative care, hospice care or both. Either may be delivered in a medical or nursing facility or, in many cases, at the dying person’s home.
- Home-Based Care
- Both palliative care and hospice care can be provided in medical facilities or in the dying person’s home. An increasing number of people have chosen to have end-of-life care in their home when possible. With hospice care in the home, the dying person’s family and friends handle the majority of caregiving responsibilities with regular visits from the hospice team.
- Hospice care focuses on the care, comfort and quality of life for a person who typically has no more than six month to live if their condition takes its natural course. With hospice care, all attempts to cure the condition are stopped. Typically, it is an option if it becomes impossible to cure the condition or if the person wants to stop further treatments. Hospice care brings together a team to cover the physical, emotional and spiritual comfort of the dying person.
- Palliative Care
- Palliative care is a type of specialized medical care that treats the symptoms of a serious condition — such as heart disease, cancer, dementia or Parkinson’s disease. Palliative care does not attempt to cure the condition — but any patient receiving palliative care can still pursue other treatments intended to cure the condition.
Choices in End-of-Life Care
While you are still healthy, it is a good time to consider what treatments you want for your end-of-life care. You should consider life support measures you would want — or not want — to prolong your life.
This should involve your thoughts on when CPR, ventilators or feeding tubes should be used to keep you alive.
In some cases, these measures can save your life. But in other circumstances, they can reduce your quality of life while causing you to die more slowly.
Advance directives can provide a clearly written and legal roadmap to your preferences if you are unable to explain your wishes when you require end-of-life care. There are other steps you can take that you should consider long before you need end-of-life care.
You can talk with an elder law attorney about what options are available for advance planning for end-of-life care.
A do-not-resuscitate (DNR) order is written by a doctor instructing health care professionals not to perform cardiopulmonary resuscitation (CPR) on you if your breathing stops or your heart stops beating.
If you want a DNR, you should have a doctor draw it up before an emergency happens. You can have the doctor draft it so it allows you to choose whether you want — or don’t want — CPR in an emergency, such as a car crash or heart attack.
A DNR only addresses CPR. It will not affect other treatments you may receive, including nutrition, pain medications or other medicines.
Palliative care and hospice incorporate pain and symptom management into their treatments.
In extreme cases, palliative sedation — which differs from routine palliative care — may be an option. Palliative sedation is a measure of last resort. It is only used at the end of life to relieve severe symptoms that cannot be brought under control despite aggressive efforts to do so while keeping the patient conscious.
Palliative sedation is a form of deep sedation that places the patient into a state of decreased awareness or even unconsciousness. In some cases, the patient may remain in this state for the remainder of their life.
Palliative sedation is most often used if the dying person is suffering pain that cannot be controlled through other treatments. It may also be used if the patient is suffering convulsions, agitated delirium, or serious breathing difficulties.
Medical Aid in Dying
Medical aid in dying allows a terminally ill, mentally capable adult with a terminal disease and six months or less to live — as determined by a medical doctor — to request a prescription that can bring about a peaceful death.
The doctor writes a prescription for a lethal amount of medicine, but the patient administers it to themself — remaining in control of when or whether to actually ingest it. In this sense, the patient is in control of when they die.
Medical aid in dying is only legal in a handful of states.
- District of Columbia
- New Jersey
- New Mexico
Medical aid in dying should not be confused with euthanasia, which is illegal in all states. Euthanasia is a deliberate act by someone other than the dying person to administer a lethal dose of medication to the dying person.
5 Cited Research Articles
- National Library of Medicine. (2022, January 29). What is palliative care? Retrieved from https://medlineplus.gov/ency/patientinstructions/000536.htm
- National Institute on Aging. (2021, December 17). Providing Care and Comfort at the End of Life. Retrieved from https://www.nia.nih.gov/health/providing-comfort-end-life
- National Institute on Aging. (2021, May 14). What Are Palliative Care and Hospice Care? Retrieved from https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care
- Agency for Healthcare Research and Quality. (2018, June). Chartbook on Person- and Family-Centered Care: End-of-Life Care Measures. Retrieved from https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/personcentered/measures5.html
- National Cancer Institute. (n.d.). end-of-life care. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/end-of-life-care