Intervention Level
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How aggressive do you want to be in the management of your own illness or in the treatment of a relative? This is a complex question that involves religious and cultural beliefs as well as as ethical decision making.

" Do everything possible " fits sometimes. This is the highest level of intervention. It involves  resuscitation after cardiac arrest and management in Intensive Care Units.

" Do nothing to prolong agony. Allow a dignified and peaceful death." This also is a reasonable choice sometimes. It is the basis for Palliative Care. It is the lowest level of intervention but often is an extremely high level of care to preserve dignity and comfort.

Between these two extremes the decisions and boundaries or guidelines are more difficult to understand, explain and  emotionally accept. What is quality of life? Can you make that decision for someone else? In the Nursing Home or Hospital setting the question is often re-worded to ask: " Are you better off staying here to manage this deterioration in your health or should you go to another facility?". In Nursing Homes some folks have reached the stage where they prefer to be treated where they are in familiar surroundings among their friends and known Caregivers. They may be terrified of changes, Emergency , strangers, excessive stimulation. These people choose to stay in the Nursing Home and accept what can be provided. This is a level 2 out of 4. Since most Nursing Homes do not provide treatments like intravenous antibiotic or re-hydration patients and families will often choose to transfer to an Acute Care Facility to have the serious condition treated with the understanding that they will return to the Nursing Home if the condition stabilizes. This is level 3 and is further qualified in that treatment in Intensive Care Units is refused and no CPR ( cardiac resuscitation ) is given.

In the Intensive Care Unit the level of intervention question comes up in a reverse way. For people who have received all the treatments possible and remain at a poor functioning level it is asked if the aggressive management should be discontinued and the patient be allowed to plateau at a level of care that does not demand constant investigation and treatment.

The details of the Levels of Intervention are not critically important. However, the fact that the patient and family are offered an opportunity to discuss the levels and that their wishes are adhered to is vital to good medical management.

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