What’s the “Downward Spiral”?

This refers typically to the last year of life for many seniors, when one “health crisis” or problem leads to another problem, with each event causing the senior to become more dependent on others for more care: a “spiraling down at the end of life”.


Do Antibiotics Help Control Symptoms?

In general they do not help comfort, certainly not at the end-of-life and sometimes not even in general terms. If the goal of the person and their family is comfort only and the last few weeks of life is approaching, then using antibiotics for any infection will not help them to be more comfortable.



Why Is It Important To Take Pain Killers Regularly If You Have Chronic Pain?

When you get hurt and have an “acute” pain, you may take something to control that pain and it usually goes away or is eased, but you only take the medicine when you feel the pain and want to reduce it. This is common for headaches, muscle strains, fractures, ligament sprains, or belly aches, and only lasts for a few hours, days or weeks. However, when a person has pain which never really goes away and continues for several months, regardless of the cause, it becomes “chronic pain”.



What’s A.N.D. (Allow Natural Death)?

A.N.D. means “Allow Natural Death” which means Do Not Do CPR (CardioPulmonary Resuscitation) when the heart stops. It was introduced in 2000 by Rev. Chuck Meyer as an attempt replace the term “DNR” (Do Not attempt Resuscitation) which is often perceived negatively (some feel that an effective treatment is being withheld from them) and can confuse both doctors and families regarding how much care to provide: some interpret it to mean “don’t give any care at all”, when all it’s intended to indicate is “No CPR”. An order for “AND” should convey to everyone: allow me to die naturally by not doing CPR and by just keeping me comfortable when it is time to die.


What’s Evidence-Based Medicine (EBM)?

The “official” definition is, “The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Practicing EBM means integrating personal clinical expertise with the best available external clinical evidence from systematic research.” [Sackett DL. Evidence-based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.]

What that really means is, use only those treatments which have been demonstrated to control symptoms and help reach the patient’s goal, and, conversely, avoid doing those things which have not shown any benefit. [Rev.8/08]

What Is Palliative Sedation (PS)?

PS is the deliberate sedation (a druginduced sleep) of a terminally ill patient whose pain or other symptoms (such as a smothering shortness of breath) cannot be controlled with expected or extraordinary doses of usual medications. Barbiturates, such as Phenobarbital, are commonly used for the sedation.


What’s The Difference Between Physician-Assisted Suicide (PAS) And Euthanasia?

Physician-Assisted Suicide is where patients with a terminal diagnosis (life-limiting disease) formally request a prescription for a fatal dose of a drug which they can administer to themselves at a time of their choosing. The term “Physician-Assisted Suicide” is being replaced with “Physician-Assisted Death”. It is a patient-initiated and controlled form of dying, to treat an unbearable situation, and is legal in two states in the U.S.A. (Oregon [Death with Dignity Act 1994] and Washington [2009]), and in Europe in The Netherlands.

Euthanasia is when a physician or other healthcare provider does something, such as administering a known lethal dose of a drug, to deliberately kill a patient, with or without the patient’s consent. It is not legal anywhere in the U.S.A.

Some physicians feel that the request for PAS or Euthanasia indicates a lack of a good Palliative Care program, which can offer Palliative Sedation (see below) to control terminal symptoms if other methods fail to do so.


How Does Morphine Help Shortness Of Breath (SOB)?

Although most people realize morphine is an excellent pain killer, it also is extremely helpful in controlling shortness of breath due to Congestive Heart Failure (CHF) or to Chronic Obstructive Lung Disease (COPD) or Emphysema. It relaxes the muscles in the bronchial/breathing tubes, making the work of breathing easier; and, it helps to control the anxiety associated with a “suffocating” feeling which may occur. It can be taken by mouth or by injection, and is usually started at a low dose (e.g. 3mg every 34 hrs) and increased as needed. (There has been no significant advantage to giving it through a nebulizer/breathing treatment.)