Ethical Choices
Ethical Choices

Part 3: Medical Care Decisions

There is a range of medical care available that can prolong life for people in the end stages of an illness. When and whether to use these measures depends on the type of medical care the person has specified. Or, if she has not left directions, the best decision based on the person's values and desires. The following are some of the measures that commonly need to be addressed.

Cardiopulmonary resuscitation or CPR is a group of treatments used to restore function when a person's heart and/or breathing stops. CPR:

  • may be painful and traumatic for the person.
  • may leave the person in worse condition.
  • may not prolong life.
  • is not recommended by many experts when a person is in the end stages of an illness. It is often not wanted by persons when they are able to make such decisions.

A "Do not resuscitate" (DNR) or "Do not attempt resuscitation" (DNAR) order tells the medical professionals not to perform CPR if the person's breathing or heartbeat stops.

Feeding tubes are sometimes suggested if a person has a hard time eating or swallowing, which is common in the late stage of Alzheimer's disease. Tube feeding has not been proven to benefit or extend life. It may result in infections and can be uncomfortable for the person. However, sometimes it is considered for a fixed time period. Talk to your health-care team about any specific plans for use of feeding tubes.

Intravenous (IV) hydration is liquid given to a person through a needle in a vein. Not being hydrated or having enough fluid in your body is a normal part of the dying process. It allows for a more comfortable death over a period of days. Using IV hydration can draw out the dying process for weeks. It may also burden the person physically. If IV use is being considered, there should be specific goals, with a limited time period that you and the health-care team agree to.

Antibiotics may be prescribed for common infections but may not improve the person's condition.


Advice from a Clinical Ethicist: Gary Goldsand

Clinical ethicist Gary Goldsand walks host Liana Shannon through the most common ethical decisions friends or family members may have to make at the end of life. Gary also explains the concept of a "good death".


Additional Reading

The Progression of Alzheimer's Disease - Overview

The Progression of Alzheimer's Disease - End of Life

All About Me

Quality of Life

Day-to-Day Series - Communication


To continue your learning experience, move ahead to Session 12 where we'll consider the changes people with dementia are likely to experience in the later stages of the disease. Life transitions and decision making will also be discussed.