Life support is such a broad term you probably haven’t given much thought to all of the medical interventions that keep people alive. The human body is a miraculous interconnecting apparatus with organs and systems that have to work in harmony to keep you alive.
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Things get complicated when deciding which (if any) life support interventions make sense in the context of specific situations. There is a difference between a 25-year-old who requires CPR to keep them alive and a frail 95-year-old who is at the end of life. Deciding when and what life supports makes sense is a lot more challenging than it may seem. You may choose palliative or hospice care or a combination of hospice and life support.
Medical technology has made great advances in ways to keep people alive, but the quality of life is also a consideration. We want to cure, treat and help people recover from illnesses and catastrophic accidents, but at what point does it make sense to withdraw or not start life support? Let’s look at the pros and cons of life support and why life support is so critical to planning your advance directives and living will.
What’s Life Support?
Life support encompasses several interventions to keep someone alive. Examples include a ventilator that helps someone breathe, a feeding tube that keeps someone nourished, dialysis to keep the kidneys working, artificial hydration, a pacemaker, high levels of oxygen, and CPR or defibrillation when the heart fails. Sometimes life support is temporary and a means to recovery, and other times if it is withdrawn, the person would die due to organ failure.
Questions to ask about life support are:
- Will the life support contribute eventually to meaningful recovery?
- What are the side effects and physical and emotional consequences of life support?
- How long will I need to be on life support?
Pros of Life Support
There are benefits to life support that can be short-term or long-term, depending on your goals. Your goals for life support may change over time, leading to different decisions later. You may choose palliative or hospice care over life support or a combination of hospice and life support. Most people think, for example, that hospice does not allow for artificial nutrition, but if the patient wants both, they have the right to request it.
1. Extends life with the possibility of recovery
The challenge with life support is that the situation is not always black and white, leading to confusion and indecision. Life support allows you to live longer, which may mean that it gives you more time to consider your options.
Depending on your diagnosis and prognosis, there might be other treatment options to consider, which takes time to process. There could be the possibility that recovery may not bring you to your previous level of functioning but to a place you are willing to accept. Asking questions about the kind of end-of-life care that you want is critical at this point and can help you forge a path forward.
Some people are unwilling to accept a lower level of functioning and a dependence on life support, and others are. Your decisions about this are yours to discuss with family and friends and are to be respected and honored.
2. Allows time with family
Life support can buy you time to be with family and also allow your family to process what is happening to you. You may decide that life support is temporary and that you will request a withdrawal at a time of your choosing. This decision allows the family time to say goodbye, be with you without time constraints, and come to terms with your death.
Family and friends who live at a distance have the time to travel to see you. You can also use this time to access spiritual counsel of your choosing.
3. Allows for organ donation
Life support allows for timely organ donation. Suitable recipients of your organs are located, life support is withdrawn, and surgeons can harvest your organs immediately, ensuring their viability for the recipient. Not everyone chooses organ donation, but for people who do want to donate at the end of life, opting for life support provides the time necessary for a seamless and successful transition.
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4. Life support can contribute to quality of life
Life support such as kidney dialysis allows people full recovery by saving their lives or allowing for quality of life. For example, someone who is frail and older may not wish to incur the inconvenience and hardship of kidney dialysis, whereas a younger, healthier person may choose this option willingly.
It can help to view life support as a variety of useful medical interventions depending on the person and the situation.
Cons of Life Support
Life support is not only a medical decision. It is a financial, ethical, and religious one, as well. There are physical, emotional, and spiritual complications of life support that you may not have thought of. Choosing life support doesn’t affect only you, but others as well. Not everyone may agree with your decision.
5. Prolonged suffering
Prolonged suffering is a critical concern when there are no advance directives in place, and someone is in a vegetative state. Families may insist on life support with the hope (reasonable or not) that their loved one will recover. Meanwhile, it is impossible to know if the person on life support is in pain or discomfort because they can’t express it.
There have been many high-profile cases, such as the Terri Schiavo case, where Terri was in an irreversible persistent vegetative state. Her husband was her legal guardian and asserted that she did not want life support if there was no hope for recovery. Terri’s parents challenged Terri’s medical diagnosis, and the legal battle went on for seven years before Terri’s feeding tube was finally removed.
6. Side effects
Many life support interventions have significant side effects. For example, tubes that provide artificial nutrition or hydration can be extremely uncomfortable and lead to infections and the risk of bleeding. Cramps, bloating, and diarrhea can also be side effects of feeding tubes.
Breathing tubes can also cause infection and damage to the trachea and nerves in the neck.
7. Ethical and religious conflicts
Families and their loved ones may have differing views on life support from an ethical standpoint. On the one hand, some people believe that it is immoral to withdraw life support from someone since it is equivalent to taking someone’s life. Then other people think it is unethical to continue life support when it causes suffering and will not lead to meaningful recovery.
These differences of opinion can cause significant family conflict, which is another good reason to have advance directives in place. Your wishes, regardless of what others think, should be stated in a living will as part of your planning. You can designate a trusted person to carry out those wishes should you be unable to do so.
8. Financial consequences
Life support is estimated to cost between $2000-$4000 a day but can climb up to $10,000 a day. If you have good insurance, it might cover some or all of the cost, but this still leaves families with potentially hundreds of thousands of dollars in out-of-pocket expenses. If there are legal issues related to a disagreement over life support for a loved one, there are also those costs. Families have gone bankrupt keeping loved ones alive or fighting legal battles.
9. A drain on limited resources
The astronomical cost of life support in cases where recovery is unlikely drains medical resources and takes up space in ICUs and hospitals. Critics of life support in these circumstances assert that these costs are passed on to the consumer in higher insurance and medical bills.
10. Quality of care vs. quantity of care
If a surrogate decision-maker chooses to keep a loved one on life support, are they doing so out of the person’s welfare, or is it to keep hope alive for recovery (like the Terri Schiavo case)? Pressure by family on a loved one can unduly influence their decision about whether to continue or discontinue life support.
Life Support Pros and Cons
There may be no more difficult decision to make than to choose life support or to withdraw it. In some ways, life was simpler decades ago when the medical interventions we have now were not available. The most important responsibility you have to yourself and your family is to plan for the unexpected by having advance directives in place that include a living will. Talk with your family and friends about the kind of compassionate care you want if life support is an option.