So recently, I was in a situation where end of life care needed to be discussed, and decided on. I had assumed that most people are aware of the options that you have. But recently, I was proved wrong. Working in healthcare, you have to advocate, a lot. Not just for your patient, but sometimes for your own family.
The common terms most people have heard of are DNR (do not resuscitate), DNI (do not intubate), and hospice and palliative care.
When you sign a DNR, you are making it known that you do not wish to be resuscitated if your heart should stop, or if you stop breathing. You do not want compressions, or medications that can be used to restart your heart or your breathing.
When you sign a DNI, you are making it known you do not want to be intubated should you stop breathing. You do not want a tube to push air in to your lungs to keep you alive.
When you request hospice and palliative care, you may not actually be near end of life. Many people with chronic pain, or cancer, choose hospice and palliative care for pain management. Of course hospice does also help with end of life care.
But not many people are aware of CMO (comfort measures only), or in Massachusetts, a MOLST (Massachusetts Medical Orders for Life Sustaining Treatment).
Comfort measures only or CMO is for people who are close to dying. It means if you are intubated, the tube keeping you breathing is alive, the fluids you are being given are stopped, typically a catheter is put in, but only for comfort, and main goal is to only keep you comfortable. Most comfort measure only patients are on pain medication, and will slip away with the next 72 hours. It’s not easy to see, but when there is nothing more that can be done for you, I consider it to be the best choice.
A MOLST is a piece of paper that asks you questions on if you’d like to be intubated, have a feeding tube, and a few other questions. It is on a hot pink piece of paper that all medical personnel know to look for. The MOLST is honored in all Massachusetts medical facilities, and should be honored if you travel.
So what’s the difference between a DNR/DNI and being comfort measures only?
Well, DNR/DNI is for people who do not wish to have CPR, be shocked, or intubated should they stop breathing or their heart stop, they will die. Comfort measures only, is for people who are intubated, and there’s nothing more medicine can do for them. An example of comfort measures only is a person that had a massive brain bleed and has no brain activity, at family request, the person was extubated and placed in pain medication to remain comfortable.
So what’s the difference between hospice and comfort measures only?
Recently, a family member of mine was on a ventilator and there was nothing more that could be done for her. If my family decided hospice, my family member would have stayed intubated and been kept alive until her heart stopped. Comfort measures only allowed us to have her taken off the ventilator, given pain medication, and let her pass away comfortably and quickly. Hospice would have prolonged the inevitable, but your doctor would be able to advise you better on which to choose.
So how do I decide?
Obviously this is not meant in any way to help you make a decision. Please speak to your primary care doctor for decisions related to any life sustaining treatment, or end of life care. They can educate you better with a more specific plan related to your medical conditions. The purpose of this was to educate people that there are more options for you.