In professions related to medicine or nursing, end-of-life care is a term for a particular kind of healthcare. It not only deals with patients in the last few hours or days of their lives, but more specifically with the care of all those patients suffering with terminal diseases or life-threatening illnesses in which the condition has become complex, progressive, and fatal. End-of-life care needs a lot of decision making as to what should be the approach of the treatment, the right of the patient to make decisions regarding his or her treatment and life, and decision making based on ethics. So, the role of decision making in end-of-life care is of utmost importance. This article aims to probe into this issue in a detailed manner.

Making decisions about healthcare treatment for your last days

It is often said that people have the capacity to make decisions if they are capable of understanding, retaining, and evaluating pertinent information and then making a choice. A person’s ability to make decisions may be negatively affected by a number of continual or acute diseases. So, the capability of decision making may differ over a period of time and naturally demand re-evaluation on a periodic basis.

A grown-up patient with the capacity to make decisions may agree to or decline some life-supporting treatments, although that decision might lead to serious worsening in health or even death. It is vital that the patient is properly educated about the penalty of declining such treatment. A patient may make a decision based on his or her choices about the treatment and the values he or she carries, even if the decision might be different from the recommendations of the treating team.

It should be noted that a patient who has the capacity to make decisions does not share the authority of decision making with the treating team. Rather, the treating professionals act as advisors and enable the patient to make suitable choices about sensible treatment options. These patients have the liberty to make decisions without any intervention from their family members or relatives.

The best solution

When the patient does not have the capability to decide his or her own care, it is recommended to go for an approach of consensus building for the purpose of end-of-life decision making that takes into account the patient’s best interests. This process of collaborative approach intends to bring into sync the patient’s values and current medical condition with the awareness and understanding of those values and conditions by the family and treating team. An agreement is required within the team responsible for treatment. Then another agreement is made between the same treating team and the family about a process of care in line with the patient’s values as much as possible, at the same time supporting the degree of the family’s wishes to be involved. The agreed-upon decision for end-of-life care related to life-sustaining treatment has to be properly documented and communicated to all the team members of the treating team.


Since 2001, Dr. Alexander Salerno has led Salerno Medical Associates in East Orange, New Jersey. Dr. Alexander Salerno focuses largely on urban communities and on delivering patient education about both medical and behavioral health issues, including end-of-life care.