Life-Sustaining Treatment Options

Stop Life-Sustaining Treatment: This is a balanced approach - try treatments, but when there is little likelihood of meaningful life left, stop.
Stop Life-Sustaining Treatments if I may not be able to Live Independently with Full Function: This is for those who prefer not to have treatments in most circumstances.
Continue Life-Sustaining Treatments. This option is for those less concerned about the financial or emotional burden on the family and who prefer treatment under any circumstances.
No Preference/Family Agent Decides: This is for clients who do not have a healthcare preference and want to leave it up to their families.

Stop Life-Sustaining Treatment Option:

“Stop-life-sustaining treatments” is the most common answer. This means if you are at the end of life and your health care agent believes you will never meaningfully interact with your friends and family again, whether due to a coma, vegetative state, severe dementia, or the likely risks and burdens of treatment would outweigh the expected benefits, your preference is asking them to stop life-support. This tends to be a balanced approach that continues treatment while it is helpful but allows clients to pass peacefully once they are at that point.

This option is not a directive to immediately stop care or a do-not-resuscitate order. If your agent wants to give the family a chance to say goodbye, get a second opinion, or otherwise need time to make this decision, your healthcare agent has the authority to wait. If your agent does not think that is necessary or has already occurred, they can also stop care immediately.

This option also includes the statement that you want to stop treatment if you have severe dementia, which we are defining as never meaningfully being able to interact with your friends or family again (not forgetting your keys – instead, no ability to communicate, the brain is not speaking with the body). We include this because there is not currently a life termination option in California that applies to a dementia diagnosis and many of our clients do not want to live with severe dementia for any period of time.

We do not recommend time limits, such as I want my health care agent to wait 30 days. In practice, 30 days can be an arbitrary number, either too long or too short. If possible, talking to your agent about your preferences and then trusting them to use their best judgment is more likely to result in a meaningful application of your wishes. For example, explaining, I would prefer to give it as much time as possible but not burden my family, or I do not want to be a burden on others; if you don’t think I will make a full recovery, stop treatment as soon as you are convinced.

No Preference/Family Agent Decides

This option is generally selected because the client wants to defer to their families’ personal preferences about when treatment ends that is not necessarily tied to a medical diagnosis. The advantage is the family may be able to take time to adjust to the situation. Some mental health professionals have noted that it can be helpful. The cost is that sometimes a directive they can point to for a decision is emotionally easier on their healthcare agent and can smooth out family disputes about what can be or should be done. This is a reasonable option and a good choice if your family works well together and generally has little conflict.

Stop Life-Sustaining Treatments if I may not be able to Live Independently

This option is generally for older clients who do not want to risk the chance of having to live with a brain injury, being a burden on family, or having to deal with a difficult recovery from an illness. Many clients requested this option during Covid because they did not want to live with reduced mental function if put on a respirator. Other clients have already had difficulty recovering and do not want to go through that again.

We recommend completing a DNR and/or POLST with your doctor if you select this option. Some clients choose this option because they want to reduce the chance of family conflict if they have a condition that could possibly be treated, but they want to lean into no-treatment options and do not want other family members to harass or try to persuade their health care agent otherwise.

Continue Life-Sustaining Treatments

This option is for individuals who want their family to continue life-sustaining treatments under any circumstances. This option tends to increase the cost and burden of medical care and might result in clients living with severe brain damage, spending more money out of the estate on their care, their family providing more medical care, possibly at the risk of their jobs, and the healthcare agents having to argue with medical recommendations.