Withholding and withdrawing mechanical ventilation: assessing quality of life.

Abstract

Introduction The phrase of is frequently used in health care. It describes a polymorphous collage embracing a patient's levelof productivity, the ability to function in daily life, the performance of social roles, intellectual capabilities, emotional stability, and life satisfaction (1, 2). Although the concept is problematic because it covers multiple dimensions and is difficult to quantify, its importance in clinical medicine is wellrecognized (3-5). The patient's quality of life, both current and predicted, plays an important role in clinical decision-making. It is part of the cost-benefit analysis inherent in every clinical judgment and in every patient decision to accept or reject a particular treatment option. In this report, we will define why the assessment of present and future potential quality of life is a critical component in decisionmaking about life-sustaining therapy, specifically, mechanical ventilation. We will summarize past approaches to the assessment of quality oflife and offer suggestions about the direction future work in this area might take. It is important to emphasize that when involved in decision-making concerning withholding and withdrawing life support, it is the patient's individual feelings about his or her own quality of life that will guide clinical management. Nevertheless, wemust still seek objective and widely applicable methods to assess quality of life independent of the patient's feelings.