Possible directions to your carers when you are terminally ill
Adapted from ‘To Die Well’ by Sidney Wanzer, MD 2007
Introduction
If you are suffering from a terminal illness, there will come a time when further attempts to cure your disease are futile and may cause you further suffering.
It is important that you ask your doctor to be frank and realistic about this.
It may be that a further course of treatment might prolong your life by a few weeks or even months but this could be at the cost of unpleasant side-effects that may make you feel more ill than you do at present.
You decide the time when the purpose of medical care is no longer to cure or modify your disease but to help you live as comfortably as possible in the time you have left — this is usually termed palliative care.
You may not want to eat and your desire to drink may become minimal, resulting in dehydration that will shorten the dying process.
Many patients prefer to die in their own homes with proper supportive care.
If you are in a nursing home or hospice, you will need to make your wishes clear and specific to those in charge. Reinforcement by family and friends will help ensure your wishes are followed.
Consider the following directions for your carers
1. Nothing is to be done that prolongs the dying process.
2. In the event of a cardiorespiratory collapse, no CPR, respirator or other resuscitative measures are to be used.
3. No antibiotics are to be administered for urinary tract, chest or other infections.
4. No intravenous fluids (including blood transfusions) are to be given.
5. If dehydration occurs, it is not to be treated by administration of fluids via any route unless I request water to drink but I am not to be urged to drink fluids.
6. No naso-gastric tube is to be used.
7. Pain or any other form of distress or agitation is to be treated with medication in sufficient doses to relieve the symptoms, even if the dose might shorten life.
8. No transfer to hospital is to be made.
9. There is no need for me to get out of bed or sit up if I do not wish to do so.
10. No laboratory tests, x-rays or vital signs (temperature, respiration, pulse rate) are to be done.
