Question

If Nelson continues to be correct about the use of advance directive by only a minority of people, how should an organization handle end-of-life decisions when patients cannot articulate their wishes?

Answer 1

Providing end-of-life care requires an understanding about how the patient and their close relatives experience the dying process and a sensitive communication style. End-of-life decisions should be handled very carefully by discussing tratment guidelines either with the patient or close relative. Four step approach as advocated by Richard Balaban may be used.

The stepwise approach is

• Initiating the discussion
• clarifying the prognosis
• identifying the end-of-life goals and
• formulating treatment protocols

In case if the patient is unable to articulate their wishes, the organization can proceed by establishing supportive relationship with family members and appointing a surrogate decision maker. The disease process and the prognosis should be explained clearly in an easy to understand simple language to the decision maker. The organization has to facilitate open discussion about desired medical care and remaining life goals of the patient. Palliative care to be started at appropriate time.