Withholding or Withdrawing Life-Sustaining Treatments

Abstract

End-of-life (EoL) decisions are an important part of intensive care activities and now most registered deaths follow a decision to forgo life-sustaining treatments (DFLST). These decisions can be carried out with two clinical practices: decision to actively stop an ongoing life-sustaining treatment that is no longer effective (withdrawing life-sustaining treatments-WDLST) or not to start a treatment because it is no longer considered to be favorable to modify the prognosis (withholding life-sustaining treatments-WHLST). Despite the broad consensus among ethics experts on the equivalence of the two practices on the moral level, the issue still generates controversies in clinical practice. This chapter presents an in-depth analysis of the scientific evidence available on this topic. More specifically, the author examines the two practices and their shared definitions, assessing clinicians’ preference and motivations towards one of the two practices; some useful arguments to thoroughly define WDLST and WHLST are then reviewed; lastly the author stresses that clinicians should not merely focus on single practice, but should instead take into account the importance of the effective and timely identification of patients who could benefit from treatments’ limitation. Only then will it be possible to decide when and how to proceed to DFLST, case by case, according to the patient clinical conditions and preferences and family members’ wishes.