When your heart isn't getting better

With the hope of restored health comes the risk that, in spite of your health care team's good intentions and your own commitment to taking good care of yourself, you may not reach your intended health goals. You may find yourself facing difficult decisions about aggressive treatments such as whether to stop or continue receiving cardiopulmonary resuscitation (CPR), or using a breathing machine and artificial feeding tube.

These are difficult and wrenching issues to confront, but it is important to make these decisions ahead of time, before your children or loved ones have to decide for you. This process is called advance care planning. It involves talking with your loved ones and your health care team about your values, beliefs, goals and your treatment option preferences. It gives you some control over what will happen to you should you become unable to speak for yourself.

Research shows that people have strong preferences about how they want to be treated at the end of life. These preferences can be honored, but that means someone has to start a conversation about it. Sometimes it can be difficult to begin a conversation about these matters with your family or with your doctor. Sometimes, patients wait for their doctor to begin this conversation. But such a conversation is difficult to work into the brief time of a scheduled office visit, and holding it bedside in the Intensive Care Unit (ICU) can be too little, too late.