What Treatment Is Best For You?

If your loved one has been diagnosed with a terminal or life-threatening illness, here are some issues for him or her to think about while considering different treatment options.

By Dr. R. Sean Morrison

You’ve just been diagnosed with a serious or life-threatening illness such as cancer, heart disease, or AIDS. While thoughts and feelings whirl, now is the time to develop a treatment plan that will allow you to meet personal goals for end-of-life care and still maintain your quality of life

The first step in setting realistic goals is to thoroughly understand the illness and all the benefits and burdens of treatment. Find out what curative or life-prolonging treatments are available and their rates of success. It is important to note that not all patients respond equally well to treatment. For example, most lung cancer patients who respond well to chemotherapy are already healthy and active before treatment is started. You should know the burdens associated with possible treatments, such as nausea, fatigue, and hair loss, and pay particular interest to the increased risk of life-threatening infections. Ask about the likelihood of hospitalization. In determining treatment options it may be helpful to know just how much time you have left. Remember that every person will be different, so ask in terms of the longest and the shortest you can expect to survive.

Once there is an understanding of the disease and treatment options, you should consider your own personal values and goals. What makes life worth living for you? What do you want to accomplish with your remaining time? Where would you like to be? In a hospital? At home? The right treatment is one that lets you realize as many goals as possible. When death is near, however, goals can change. Increasing emphasis should be placed on comfort while current and future treatments should be specifically evaluated for how much they contribute to a patient’s comfort. Treatments that do not enhance or contribute to comfort should probably not be undertaken.

I always discuss the value of treatments such as artificial nutrition and hydration (tube feeding or feeding by vein), mechanical respiration (being placed on a ventilator), and cardiopulmonary resuscitation. For patients near the end of life, these treatments rarely prolong life appreciably and they do not enhance comfort. All too often, patients and physicians think that only two treatment options exist: those directed at prolonging life or securing a cure, and those directed at comfort. In fact, the two can coexist. As a disease progresses, or responds to treatment, physicians, patients, and family members should re-evaluate and modify care goals. Avoid any treatment that does not contribute to end-of-life care goals.

Dr. R. Sean Morrison is an Assistant Professor in the Department of Geriatrics and Medicine and Director of Research of the Hertzberg Palliative Care Institute at New York City’s Mt. Sinai School of Medicine. Dr. Morrison has received numerous awards for his work in geriatric and end-of-life care. Dr. Morrison is a graduate of the University of Chicago Medical School, and has been with Mt. Sinai since 1993.

© Copyright Educational Broadcasting Corporation/Public Affairs Television, Inc. Reprinted with permission.



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