Hard Choices for Loving People: CPR, Artificial Feeding, Comfort Care and the Patient with a Life-Threatening Illness, Fifth Edition is a guide to help patients and families with end-of-life decisions. Millions of people have been helped and comforted by the common sense and practical advice found in these pages. Hank Dunn draws on his extensive experience as a chaplain in a nursing home, hospice program and hospital. In Hard Choices he shares stories of many of the patients and families he has help guide through this most difficult and important time in their lives. He also has conducted a thorough search of the medical literature citing almost 150 journal articles of research into the topics discussed in the book.
In the very first pages the reader is encouraged to first consider the goals of medical care. What is the appropriate medical goal for this patient at this phase of life? Is it to (1) cure, (2) stabilize functioning or to (3) prepare for a comfortable and dignified death?
The first chapter deals with CPR, resuscitation attempts. Research has shown that this treatment offers little if any medical benefit to patients who have more that one or two medical problems, who cannot live independently or those who are in the final stages of a terminal disease. Chaplain Dunn is convinced that patients in those conditions or their families choose ineffective resuscitation attempts for emotional and spiritual reasons, not because the treatment offers hope of saving the life.
The second chapter addresses the issues surrounding artificial feeding tubes. Receiving nutrition and hydration through a tube helps many patients who have lost the ability to swallow. Some of these patients live otherwise normal lives except for receiving food and water through a tube. But for some people the treatment offers little if any benefit. There is a growing body of research that clearly shows that an artificial feeding tube for an advanced dementia patient (like Alzheimer s) has no medical benefit and can actually harm the patient. Dunn also reviews the evidence supporting the fact that dying without artificial hydration is the compassionate, natural and peaceful way to leave this world.
Hospice, respirators, dialysis, antibiotics, hospitalization and pain control are other medical treatments covered in Hard Choices for Loving People. In several places throughout the book special attention is given to making these decisions for children and for people with dementia.
The concluding pages of the book address the emotional and spiritual concerns at the end of life. People of any faith or of no faith tradition have found these words helpful. Chaplain Dunn feels the journey at the final stages of life is a journey to letting go and letting be. The Spanish version of this book is titled Decisiones Dificiles para los Seres Queridos.
