End of Life Care: Cost versus Care, When Do We Stop?

The practice of critical care is frequently full of ethical and spiritual conflict. As Associate Chief Nursing Officer in an academic hospital we were frequently challenged with the challenges when is care futile, and are we doing what is in the best interest of patients. Families are frequently asked to make complex decisions regarding care of their loved ones in crisis situations. Many times they do not understand the complex words, treatments, and choices and the long term impact of the decisions made in that emotional time. As healthcare providers we are caught between what we “can do” versus what we “should do” and where will the patients and families access the resources to deal with long term life-sustaining machines, complex care needs, and services. I have talked with numerous families who were forced to make complex decisions about complicated care under extreme emotional exhaustion and fear who later talked about “if I had only known it would be like this” would have made alternative decisions. The purpose of this presentation would be to discuss these situations along with relevant review of the literature to facilitate discussion and explore how to help navigate the experience of end of life care. Are we really helping? And how do we know