Treatment limitations

Treatment limitations mean a decision to refrain from futile or harmful treatments.

Nobody should receive treatment that is futile or that only increases suffering. That’s why it’s important to discuss treatments and examinations that it’s best to refrain from with a doctor. These decisions are referred to as treatment limitations. The decisions are discussed with and made in cooperation with the patient, as well as the patient’s family or other loved ones if necessary.

A person has the right to refuse any treatment, in which case they are offered the best possible treatment available. On the other hand, treatment that is clearly futile or harmful from a medical standpoint cannot be offered, even if the patient or their loved ones request it.

Do not resuscitate - DNR

A timely decision to refrain from resuscitation is a part of good-quality treatment for an advanced illness, and it should be made at the right time, in cooperation with a doctor. The initiative can even come from the patient.

A “do not resuscitate” order only rules out attempted resuscitation in the event of cardiac arrest. All other forms of treatment aimed at helping the patient are carried out as usual.

To make the decision easy to locate in a patient record, it’s referred to by abbreviations.

Examples include

DNR
(Do Not Resuscitate)
DNAR
(Do Not Attempt to Resuscitate)
ER
(“Ei Resuskitoida” = no resuscitation).

Intent of attempted resuscitation

In the event of cardiac arrest due to an acute illness, resuscitation can be attempted in order to restart the heart. If successful, this practically always leads to treatment in an intensive care unit. A full recovery is only possible if the acute cause of cardiac arrest (for example heart attack) can be treated. Resuscitation or intensive care do not cure a person on their own. Therefore, if a person already has an incurable, highly advanced illness, resuscitation only increases suffering without the possibility of recovery. In such an event, artificial life support does not revive the person, and a natural death should be allowed to occur.

Other treatment limitations

Treatments and examinations

In addition to attempted resuscitation, there are forms of treatment at the end of life that no longer benefit the patient or that only prolong suffering without improving the patient’s quality of life. These may include mechanical ventilation, dialysis, or surgical procedures.

Likewise, procedures such as blood tests, endoscopies, or X-ray imaging should not be carried out unless the results are meaningful in terms of treatment decisions. Examinations that only aim to satiate a hunger for knowledge put the patient under unnecessary strain.

In palliative care, the aim of examinations should be to provide treatment that offers better symptom relief.

Hydration during hospice care

A person receiving hospice care is assisted with eating and drinking for as long as it feels good for the person to do so. On the other hand, giving a dying person fluids into a vein causes a build-up of fluid in the tissues, often resulting in swelling and shortness of breath without making the person feel better.

Hospital transfers

For a frail elderly person with an advanced memory disorder, being transferred from a familiar place of care to a hospital emergency department often leads to anxiety and delirium. That’s why it’s important to carefully consider in advance whether it’s sensible to transfer the person to a hospital, and whether it would be possible to provide symptom relief in the patient’s regular place of care instead.

Antibiotics

Antibiotics are intended to restore a person’s quality of life once the infection is cured. However, in the case of a dying person’s death rattle or fever, they usually offer no relief.