What is Life-Sustaining Treatment?
Medical care can save lives. Many people who become very sick recover, return to their daily activities, and live independently again. However, some people who are very ill or have several serious medical conditions may not return to their previous quality of life.
When a person is seriously ill, whether from a sudden injury or illness or a long-term condition, his or her healthcare team may discuss which treatments are likely to help and which may cause more harm than benefit.
For example, as dementia worsens, a person may lose the ability to eat or swallow safely. In such cases, feeding tubes do not usually help a person live longer and may cause discomfort or infection. Another example is CPR. CPR may not restart the heart in someone who has serious medical conditions, such as cancer or sepsis, and often causes broken ribs.
Any person who is able to make medical decisions has the right to refuse treatment. Based on their personal values and priorities, individuals may choose to decline certain treatments, even if those treatments could save their life or help them live longer.
Healthcare providers must respect a person’s decisions about their medical care. (Read more about informed consent).
Treatments can be stopped if they are not helping or if they no longer match the person’s medical goals.
If a person chooses not to start or decides to stop life-sustaining treatment, they can still receive medical care focused on comfort. This care can treat symptoms such as pain or shortness of breath.
Life-sustaining treatments and advance directives
It is helpful for patients and their healthcare providers to discuss advance directives. These written documents make a person’s medical wishes known if they are no longer able to speak for themselves.
When completing advance directives, a person should think about their goals for care at the end of life. For example:
- Is the goal to live as long as possible?
- Is the goal to treat medical problems but avoid treatments that are painful or not helpful?
- Is the goal to focus on comfort?
- Is the goal to maintain a good quality of life, including the ability to do activities the person enjoys?
Advance directives can help prevent unwanted treatments at the end of life. They can also ensure that a person receives the care they want. It is important to understand that advance directives are not permanent. A person can change their decisions at any time in the future.
End of Life Symptoms
Certain symptoms are common near the end of life. Not all of these symptoms cause discomfort. However, if they appear distressing, they should be treated.
Loss of appetite
As a person approaches the end of life, their appetite usually decreases. This is a natural change, like when someone is sick and does not feel like eating. At the end of life, appetite stimulants and feeding tubes do not improve comfort or help a person live longer. If the person is able to eat, they should be offered foods they enjoy, including items such as ice cream or milkshakes. Ice chips, ice pops, moist swabs, or artificial saliva can help prevent the mouth from becoming uncomfortably dry or cracked.
Breathlessness (also known as dyspnea)
Some people near the end of life may feel short of breath. A person can feel breathless even if oxygen levels are normal. Moving cool air across the face with a small fan may help. Physicians may also recommend medications or oxygen therapy to ease symptoms.
Terminal respiratory secretions
This condition occurs very near to the end of life, when fluid collects in the back of the throat because a person can no longer swallow or cough effectively. This fluid collection results in a characteristic sound, often called a “death rattle”. This condition is not painful. Raising the head of the bed or using medications to reduce secretions may help.
Care and Treatment
Palliative Care
Palliative care is medical care that focuses on improving quality of life. It works to relieve symptoms and support patients and families during serious illness. Palliative care can help anyone with a serious condition, no matter how long they are expected to live. Primary care providers or medical specialists can provide palliative care.
Hospice Care
Hospice care is specialized care for people who are expected to live six months or less. Hospice focuses on comfort and symptom relief rather than treatments meant to extend life. Beginning hospice care as early as possible in life-limiting illnesses allows patients and families to receive more support.
Hospice care can be provided at home, in an assisted living facility, in a nursing home, or in an inpatient hospice facility in some cases. The hospice team may include a physician or nurse practitioner, nurse, home health aide, social worker, chaplain, and trained volunteers.
Team members visit regularly and are available by phone 24 hours per day, seven days per week. However, most daily care is provided by family members, friends, or staff at the care facility.
End-of-Life Considerations
Several medical orders require attention when a person is nearing the end of life.
Do-Not-Resuscitate (DNR) Orders
CPR (cardiopulmonary resuscitation) can be effective in cases of sudden and unexpected cardiac arrest. However, it is often less effective for people who are close to the end of life or who suffer from multiple serious chronic diseases.
A healthcare professional can write a “Do-Not-Resuscitate” (DNR) order. This order tells medical staff not to perform CPR if the person’s heart stops. People who have an implantable cardioverter defibrillator (ICD) can speak with their healthcare provider about turning off the device near the end of life to prevent painful shocks, if this matches their goals of care.
Orders for Life-Sustaining Treatment
Most states offer forms that convert a person’s care preferences into medical orders signed by a physician. These orders guide healthcare professionals and may prevent life-sustaining treatments, such as CPR.
These forms may have different names, including:
- Physician Orders for Life-Sustaining Treatment (POLST)
- Medical Orders for Life-Sustaining Treatment (MOLST)
- Physician Orders for Scope of Treatment (POST)
- Medical Orders for Scope of Treatment (MOST)
Most state POLST forms are available through the National POLST website.
Artificial Feeding and Hydration
People who are seriously ill or near death often eat and drink less. This is a normal part of the dying process, but it can be difficult for family members and caregivers to witness.
Artificial feeding and hydration are generally not recommended near the end of life because they may cause swelling, aspiration (food or fluid entering the lungs), or discomfort. If the person can eat or drink, offer small sips or bites of foods and drinks they enjoy.
Medical Aid in Dying
Medical aid in dying is a practice in which a physician provides a terminally ill patient, at the patient’s request, a prescription for medication to end their own life.
Oregon was the first state to legalize medical aid in dying. Since then, 10 other states and Washington, D.C., have legalized the practice. Legal and medical requirements are strict. The person must take the medication themselves. Studies show that many people who obtain the medication do not end up using it.
Last Updated April 2026