When an Advance Decision would apply
Chronic heart and chest (lung) disease result in periods of well being interspersed with acute episodes of illness. There are two different circumstances when patients with heart or chest disease lose the ability to make their own decisions about their health.
The first is due to an acute illness; respiratory or heart failure or infection are the common causes. Recovery from this acute illness will depend on the patient's underlying state of health and general nutrition as well as the severity of the acute illness and any additional complication.
The second is towards the very end when a small number of patients go into a coma. In this situation an Advance Statement of preferences and wishes as well as an Advance Decision to refuse treatment are most useful.
Symptoms and feelings associated with end stage heart or chest disease
Palliative care may last weeks or months - each patient's experience is different. During your treatment you will feel well to start off with, but as your condition progresses and gets worse you may suffer from some, or all of the following symptoms:
- Pain, shortness of breath, feeling drowsy (lethargy), loss of appetite and a general feeling of being unwell - these are the most common symptoms.
- If you are in pain you will be treated with medicines for pain relief. These medicines may cause constipation.
- Towards the very end of your life you might feel that 'you can't get comfortable', or that your body is 'a constant problem'.
The psychological feelings people have when they are getting close to the end of their life can be very different. Some people have a sense of 'it's time to give up'. Others become depressed - not clinically depressed but rather sad that the end of their life is approaching. These psychological changes might make the physical symptoms worse.
Advance Decision for heart or chest failure
In the late stages of heart or chest disease, your condition will eventually lead to your death. During this time you will be in full control of your life and be able to make all decisions about your health and the treatments offered. If however you go into a coma or a minimally conscious state, your Advance Decision will come into effect.