Hospital Policy Variation in Addressing Decisions to Withhold and Withdraw Life-Sustaining Treatment

Abstract

BackgroundSociodemographic disparities in clinician decisions to withhold and withdraw life sustaining treatment exist. Little is known about the content of hospital policies that guide clinicians involved in these decisions. Research QuestionWhat is the prevalence of United States hospitals with policies that address withholding and withdrawing life sustaining treatment; how do these policies approach ethically controversial scenarios; and how do these policies address sociodemographic disparities in decisions to withhold and withdraw life sustaining treatment? Study Design and MethodsThis national cross-sectional survey assessed the content of hospital policies addressing decisions to withhold or withdraw life sustaining treatment. We distributed the survey electronically to American Society of Bioethics and Humanities members between July and August 2023 and descriptively analyzed responses. ResultsAmong 93 respondents from hospitals or hospital systems representing all 50 US States, Puerto Rico, and Washington, DC, 92% had policies addressing decisions to withhold or withdraw life sustaining treatment. Hospitals varied in their stated guidance, permitting life sustaining treatment to be withheld or withdrawn in cases of patient or surrogate request (82%), physiologic futility (81%), and “potentially inappropriate” treatment (64%). Of the 8% of hospitals with policies that addressed patient sociodemographic disparities in decisions to withhold or withdraw life sustaining treatment, these policies provided opposing recommendations to either exclude sociodemographic factors in decision-making or actively acknowledge and incorporate these factors in decision-making. Only 3% of hospitals had policies that recommended collecting and maintaining information about patients for whom life sustaining treatment was withheld or withdrawn that could be used to identify disparities in decision-making. InterpretationWhile most surveyed United States hospital policies addressed withholding or withdrawing LST, these policies varied widely in criteria and processes. Surveyed policies also rarely addressed sociodemographic disparities in these decisions.