terminal illness terminal illness terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. this term is more commonly used for progressive diseases such as cancer, dementia or advanced heart disease than for injury. in popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. a patient who has such an illness may be referred to as a terminal patient, terminally ill or simply as being terminal. there is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. an illness which is lifelong but not fatal is a chronic condition. this article is about fatal diseases. for the alternative definition of eyestrain, see computer vision syndrome. for other uses, see terminal. terminal patients have options for disease management after diagnosis. examples include caregiving, continued treatment, palliative and hospice care, and physician-assisted suicide. decisions regarding management are made by the patient and their family, although medical professionals may offer recommendations of services available to terminal patients. lifestyle after diagnosis varies depending on management decisions and the nature of the disease, and there may be restrictions depending on the condition of the patient. terminal patients may experience depression or anxiety associated with impending death, and family and caregivers may struggle with psychological burdens. psychotherapeutic interventions may alleviate some of these burdens, and is often incorporated into palliative care. because terminal patients are aware of their impending deaths, they have time to prepare for care, such as advance directives and living wills, which have been shown to improve end-of-life care. while death cannot be avoided, patients can strive to die a death seen as good. management main article: end-of-life care by definition, there is not a cure or adequate treatment for terminal illnesses. however, some kinds of medical treatments may be appropriate anyway, such as treatment to reduce pain or ease breathing. some terminally ill patients stop all debilitating treatments to reduce unwanted side effects. others continue aggressive treatment in the hope of an unexpected success. still others reject conventional medical treatment and pursue unproven treatments such as radical dietary modifications. patients' choices about different treatments may change over time. palliative care is normally offered to terminally ill patients, regardless of their overall disease management style, if it seems likely to help manage symptoms such as pain and improve quality of life. hospice care, which can be provided at home or in a long-term care facility, additionally provides emotional and spiritual support for the patient and loved ones. some complementary approaches, such as relaxation therapy, massage, and acupuncture may relieve some symptoms and other causes of suffering. caregiving terminal patients often need a caregiver, who could be a nurse, licensed practical nurse or a family member. caregivers can help patients receive medications to reduce pain and control symptoms of nausea or vomiting. they can also assist the individual with daily living activities and movement. caregivers provide assistance with food and psychological support and ensure that the individual is comfortable. the patient's family may have questions and most caregivers can provide information to help ease the mind. doctors generally do not provide estimates for fear of instilling false hopes or obliterate an individual's hope. in most cases, the caregiver works along with physicians and follows professional instructions. caregivers may call the physician or a nurse if the individual: experiences excessive pain. is in distress or having difficulty breathing. has difficulty passing urine or is constipated. has fallen and appears hurt. is depressed and wants to harm themselves. refuses to take prescribed medications, raising ethical concerns best addressed by a person with more extensive formal training. or if the caregiver does not know how to handle the situation. most caregivers become the patient's listeners and let the individual express fears and concerns without judgment. caregivers reassure the patient and honor all advance directives. caregivers respect the individual's need for privacy and usually hold all information confidential. palliative care palliative care focuses on addressing patients' needs after disease diagnosis. while palliative care is not disease treatment, it addresses patients' physical needs, such as pain management, offers emotional support, caring for the patient psychologically and spiritually, and helps patients build support systems that can help them get through difficult times. palliative care can also help patients make decisions and come to understand what they want regarding their treatment goals and quality of life. palliative care is an attempt to improve patients' quality-of-life and comfort, and also provide support for family members and carers. additionally, it lowers hospital admissions costs. however, needs for palliative care are often unmet whether due to lack of government support and also possible stigma associated with palliative care. for these reasons, the world health assembly recommends development of palliative care in health care systems. palliative care and hospice care are often confused, and they have similar goals. however, hospice care is specifically for terminal patients while palliative care is more general and offered to patients who are not necessarily terminal. hospice care while hospitals focus on treating the disease, hospices focus on improving patient quality-of-life until death. a common misconception is that hospice care hastens death because patients "give up" fighting the disease. however, patients in hospice care often live the same length of time as patients in the hospital. a study of 3850 liver cancer patients found that patients who received hospice care, and those who did not, survived for the same amount of time. in fact, a study of 3399 adult lung cancer patients showed that patients who received hospice care actually survived longer than those who did not. additionally, in both of these studies, patients receiving hospice care had significantly lower healthcare expenditures. hospice care allows patients to spend more time with family and friends. since patients are in the company of other hospice patients, they have an additional support network and can learn to cope together. hospice patients are also able to live at peace away from a hospital setting; they may live at home with a hospice provider or at an inpatient hospice facility. medications for terminal patients terminal patients experiencing pain, especially cancer-related pain, are often prescribed opioids to relieve suffering. the specific medication prescribed, however, will differ depending on severity of pain and disease status. there exist inequities in availability of opioids to terminal patients, especially in countries where opioid access is limited. a common symptom that many terminal patients experience is dyspnea, or difficulty with breathing. to ease this symptom, doctors may also prescribe opioids to patients. some studies suggest that oral opioids may help with breathlessness. however, due to lack of consistent reliable evidence, it is currently unclear whether they truly work for this purpose. depending on the patient's condition, other medications will be prescribed accordingly. for example, if patients develop depression, antidepressants will be prescribed. anti-inflammation and anti-nausea medications may also be prescribed. continued treatment some terminal patients opt to continue extensive treatments in hope of a miracle cure, whether by participating in experimental treatments and clinical trials or seeking more intense treatment for the disease. rather than to "give up fighting," patients spend thousands more dollars to try to prolong life by a few more months. what these patients often do give up, however, is quality of life at the end of life by undergoing intense and often uncomfortable treatment. a meta-analysis of 34 studies including 11,326 patients from 11 countries found that less than half of all terminal patients correctly understood their disease prognosis, or the course of their disease and likeliness of survival. this could influence patients to pursue unnecessary treatment for the disease due to unrealistic expectations. transplant for patients with end stage kidney failure, studies have shown that transplants increase the quality of life and decreases mortality in this population. in order to be placed on the organ transplant list, patients are referred and assessed based on criteria that ranges from current comorbidities to potential for organ rejection post transplant. initial screening measures include: blood tests, pregnancy tests, serologic tests, urinalysis, drug screening, imaging, and physical exams. for patients who are interested in liver transplantation, patients with acute liver failure have the highest priority over patients with only cirrhosis. acute liver failure patients will present with worsening symptoms of somnolence or confusion (hepatic encephalopathy) and thinner blood (increased inr) due to the liver's inability to make clotting factors. some patients could experience portal hypertension, hemorrhages, and abdominal swelling (ascites). model for end stage liver disease (meld) is often used to help providers decide and prioritize candidates for transplant. physician-assisted suicide physician-assisted suicide (pas) is highly controversial, and legal in only a few countries. in pas, physicians, with voluntary written and verbal consent from the patient, give patients the means to die, usually through lethal drugs. the patient then chooses to "die with dignity," deciding on his/her own time and place to die. reasons as to why patients choose pas differ. factors that may play into a patient's decision include future disability and suffering, lack of control over death, impact on family, healthcare costs, insurance coverage, personal beliefs, religious beliefs, and much more. pas may be referred to in many different ways, such as aid in dying, assisted dying, death with dignity, and many more. these often depend on the organization and the stance they take on the issue. in this section of the article, it will be referred to as pas for the sake of consistency with the pre-existing wikipedia page: assisted suicide. in the united states, pas or medical aid in dying is legal in select states, including oregon, washington, montana, vermont, and new mexico, and there are groups both in favor of and against legalization. some groups favor pas because they do not believe they will have control over their pain, because they believe they will be a burden on their family, and because they do not want to lose autonomy and control over their own lives among other reasons. they believe that allowing pas is an act of compassion. while some groups believe in personal choice over death, others raise concerns regarding insurance policies and potential for abuse. according to sulmasy et al., the major non-religious arguments against physician-assisted suicide are quoted as follows: (1) "it offends me", suicide devalues human life; (2) slippery slope, the limits on euthanasia gradually erode; (3) "pain can be alleviated", palliative care and modern therapeutics more and more adequately manage pain; (4) physician integrity and patient trust, participating in suicide violates the integrity of the physician and undermines the trust patients place in physicians to heal and not to harm" again, there are also arguments that there are enough protections in the law that the slippery slope is avoided. for example, the death with dignity act in oregon includes waiting periods, multiple requests for lethal drugs, a psychiatric evaluation in the case of possible depression influencing decisions, and the patient personally swallowing the pills to ensure voluntary decision. physicians and medical professionals also have disagreeing views on pas. some groups, such as the american college of physicians (acp), the american medical association (ama), the world health organization, american nurses association, hospice nurses association, american psychiatric association, and more have issued position statements against its legalization. the acp's argument concerns the nature of the doctor-patient relationship and the tenets of the medical profession. they state that instead of using pas to control death: "through high-quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live out life's last chapter." other groups such as the american medical students association, the american public health association, the american medical women's association, and more support pas as an act of compassion for the suffering patient. in many cases, the argument on pas is also tied to proper palliative care. the international association for hospice and palliative care issued a position statement arguing against considering legalizing pas unless comprehensive palliative care systems in the country were in place. it could be argued that with proper palliative