Advances in medical technology have changed the way we live – and the way we die.  As we approach the end of our lives, many of us will need to make choices, some simple – some complex.  Knowing and understanding the options available can help us make decisions that are right for us.

Throughout most of our lives, aggressive curative medical treatment is the appropriate choice.   Medical procedures commonly extend our lives, even if we've been severely injured or have a serious disease such as heart disease or cancer.   Treatment can give us many extra years and a good quality of life and function. Sometimes, though, the procedures that extend life are marginal in their benefit and can even turn living into a burden. 

In the absence of a clear directive from a patient or if there is disagreement among family who are making decisions for a patient, the most aggressive path of care is usually followed.  However, there is a wide range of what is acceptable from legal, ethical, moral, and medical points of view.  At one end of the spectrum is the use of every possible technology to prolong life and at the other end (for most of the U.S.) the option to forego curative treatment and choose comfort care instead.  In Oregon, through their 1997 Death with Dignity Act, terminally-ill Oregonians are allowed to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.

Before any decision is made, however, you need to understand your own unique situation and its likely future course.  The more you and your family know, the better able everyone will be able to cope with what is happening.

It's your doctor's responsibility to guide you and answer the difficult questions (see Questions to Ask Your Doctor).  You'll want to talk about the probable outcomes of your illness and how it will cause your death.  You need to know your odds of recovery, regaining function and having an acceptable quality of life (as you define it).

As you talk to your doctor, know that the conversation is not easy for him or her.  Your doctor may be concerned about instilling false hope or destroying hope; about over- or under-estimating your remaining time; about finding the right balance of knowing when to keep aggressive and often painful treatment going and when to stop it.  If, after talking to your doctor, you still have doubts, seek a second opinion.  A second opinion not only assures you that a mistake has not been made, but it can offer another perspective that can add to everyone's understanding and peace of mind.