Withdrawing and withholding life-sustaining therapies are not the same

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Withdrawing and withholding life-sustaining therapies are not the same

Publisher
BioMed Central
Publication Date
Source
PMC
Keywords
Disciplines
  • Medicine
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Unknown

Abstract

230 ICU = intensive care unit. Critical Care June 2005 Vol 9 No 3 Levin and Sprung Abstract Numerous lines of evidence support the premise that withholding and withdrawing life support measures in the intensive care unit are not the same. These include questionnaires, practical observations and an examination of national medical guidelines. It is important to distinguish between the two end of life options as their outcomes and management are significantly different. Appreciation of these differences allows the provision of accurate information, and facilitates decision making that is compassionate, caring and adherent to the needs of the patient and their family. During rounds in the critical care unit a discussion arises regarding continued antibiotic therapy in a patient who has not responded. Should antibiotics be added, should the current therapy be maintained, or should the antibiotics be stopped? No one would dispute that these options are different. Replacing the word ‘antibiotics’ with ‘inotropes’, ‘ventilation’, or ‘life support’ does not alter this reality. Stopping life-support measures (withdrawal of therapy) is not the same as refraining from starting them (withholding) or maintaining current therapy. The former is an active measure, whereas the latter two are passive. Often patients’ families clearly understand this difference; they ask, ‘Are you just going to let him [the patient] go doctor, or are you going to pull the plug?’ An appreciation of the differences between withdrawing and withholding life-support therapies can also be found in the medical literature from physician questionnaires and empirical observations of end-of-life practice. The experience of withholding as compared to withdrawing therapy has been examined in two large questionnaire-based surveys, one from North America and the other from Europe. In the North American study [1] 26% of physicians reported being more disturbed at the prospect of withdrawing therapy than they were about withholding. S

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