When the end is near, there are decisions to be made. These are not easy decisions for many patients and their families. This is called end of life care.

Whether it is a terminal disease that has ravaged the body with no hope of recovery in spite of medical technology and continued treatments or if heroic measures have already been implemented but to no avail, you and your family or power of attorney for health care will be asked what your wishes are. Do you want to be a "full code" with CPR (cardiopulmonary resuscitation with the possibility of shocking the heart and need to be placed on a ventilator) or would you want to be made a DNR (do not resuscitate)? Many times the patient is unable to answer these questions as they may well be in a coma and unable to respond.

If you have planned ahead and made an advanced directive or living will, it is now that these directives may help your family in the decision making process. There may be multiple organ failure... the kidneys have failed, the heart is weakened and causing fluid to build up in the lungs making it difficult to breath, the brain may be affected, the liver may be failing. We cannot survive without these vital organs.

We talk about quality of life. Is there pain? Difficulty breathing? The inability to interact due to coma? Can the body no longer rid itself of toxins due to failing organs? Before decisions can be made, there needs to be a frank discussion with the doctors treating the patient. What is the prognosis? Can this patient recover?

"Do Not Resuscitate" means comfort care... no heroics... no CPR, and if the patient is not already on a ventilator, then no ventilator. The patient may be placed on hospice care or palliative care. There will be pain medicines given to promote comfort and multiple x-rays, blood tests, and treatments may be stopped. If a patient is already on a ventilator, there may be decisions about withdrawing life support and removing the patient from a ventilator.

These are difficult decisions, to say the least, but very necessary. As hard as it is to let go, these are loving decisions. You must use today's technology not only with your brain but also with your heart. Is it morally right to prolong the dying process when there is no hope for survival? Talk with your doctors, nurses, social workers, clergy and hospital ethics committee if need be, in making these decisions and then do what is right for the patient.