Continuing, Withdrawing, and Withholding Medical Treatment at the End of Life and Associated Characteristics: a Mortality Follow-back Study

Abstract

Background: Studies on forgoing treatment often ignore treatments that are continued until death. Objective: To investigate how often specific treatments are withdrawn or withheld before death and to describe the associated patient, physician, and care characteristics. Design: National mortality follow-back study in Switzerland in 2013/2014 using a standardized survey to collect information on the patient’s end of life and demographics on the physician. Participants: A random sample of adults who died non-suddenly without an external cause and who had met the physician completing the survey (N = 3051). Main Measures: Any of nine specific treatments was continued until death, withdrawn, or withheld. Key Results: In 2242 cases (84%), at least one treatment was either continued until death or withheld or withdrawn. The most common treatment was artificial hydration, which was continued in 23%, withdrawn in 4%, and withheld in 22% of all cases. The other eight treatments were withdrawn or withheld in 70–94% of applicable cases. The impact of physician characteristics was limited, but artificial hydration, antibiotics, artificial nutrition, and ventilator therapy were more likely to be withheld at home and in nursing homes than in the hospitals. Conclusions: Large differences exist between care settings in whether treatments are continued, withdrawn, or withheld, indicating the different availability of treatment options or different philosophies of care. While certain patient groups are more likely to have treatment withheld rather than attempted, neither patient nor physician characteristics impact the decision to continue or withdraw treatment.