End-of-Life Decisions

We make decisions every day of our lives.  Some are big and life-changing, while others are less impactful.  Should I have that second brownie, or should I not?  Should I wear blue or green today?  Should I quit my job, or should I stay?  While the magnitude of these questions obviously carry wildly different significance, the degree to which we struggle to determine an answer is usually oddly similar.  The reason – it is hard to know what to do most of the time.  It is hard to know for sure what the right answer is.  It is always the right decision to take the second brownie. 

One question most all of us will face at some point is what to do when facing a life-limiting illness?  The good news is, you have options and it is your right to choose.  Continuing aggressive treatments for your illness is one avenue that you can take.  For example, a feeding tube to supplement nutrition and external ventilation can be utilized.  Also, chemotherapy or other aggressive pharmaceutical interventions may be used.  Another route may be palliative care.  Palliative care is a combination of continuing certain aggressive treatments, while treating the symptoms that go along with end-of-life scenarios.  When terminal illnesses progress to end-stage levels, hospice becomes the best alternative.  

While no one can give you the perfect answer for your end-of-life situation, there are definite criteria that can point towards knowing if it is time to seek a hospice consultation. 

Here are some of the most common hospice diagnoses and the indications that hospice is appropriate: 


  • Curative treatment unlikely to improve quality or length of life
  • Metastasis to multiple sites

Heart Failure

  • Chest pain and/or shortness of breath with and without activity
  • Taking multiple cardiac medications
  • Patient and/or physician believe heart surgery is not a preferred option

Chronic Obstructive Pulmonary Disease (COPD)

  • Shortness of breath at rest and with any activity
  • Recurring respiratory infections
  • Using multiple inhalers with poor response


  • Speaks few intelligible words
  • Needs help to sit up
  • Unable to walk without assistance


  • Difficulty swallowing, unable to take in adequate nutrition
  • No feeding tube (current or planned)

Liver Failure

  • Ascites despite use of diuretics
  • Serum albumin 1.5

Renal Failure

  • Considering stopping dialysis
  • Serum creatinine >8.0 (>6.0 for diabetics)


  • CD4+ count 100,000
  • Secondary conditions (Kaposi’s sarcoma, pneumocystis pneumonia, fungal infections, etc.)

Amyotrophic Lateral Sclerosis (ALS)

  • Barely intelligible speech
  • Significant shortness of breath
  • Difficulty swallowing accompanied by rapid weight loss
  • No feeding tube or ventilator (current or planned)

You have to decide the best answer for your situation, but it is good to know that you have options.  We find that people usually tell us that they wish they knew about hospice sooner.  If you or a loved one are facing a life-limiting illness, give us a call and let us help you navigate your options when it matters most.