Making the decision to withdraw or withhold life support: Thoughts and questions

Abstract

The severity of illness of patients who enter the intensive care unit (ICU) render it a setting where death is common. End-of-life decision-making for the ICU patient has been a hot topic in recent years. This paper presents our comments, concerns and thoughts for making the decision to withdraw or withhold life support in the ICU. What is the optimal approach to such decisions? What are the indications, benefits, and ethical dilemmas of either choice? What is the current preference worldwide? The databases that were searched included The Cochrane Library Database, Medline, and EMBASE. Articles were also identified through a general internet search using the Google search engine. As a general principle, when the goals of care cannot be achieved with aggressive life-sustaining treatments, it is appropriate to withdraw these treatments and to allow death to occur. However, decisions concerning withdrawal of life support remain one of the most difficult emotional burdens for an ICU team given that these decisions encompass complex emotional and ethical questions that affect patients, family members, and care providers. Doctors must have the conscience or the “courage” to stop a treatment which no longer makes sense, provides no further benefit to the patient, causes discomfort or pain and prolongs the use of limited resources. Doctors are privileged to be able to assist their patients in their final journey through the dying process. As such, they have a duty to ensure that their patients die with dignity. Although doctors may stop active treatment, they must never stop patient care; withdrawal of therapy does not mean withdrawal of care.