Forgoing life-sustaining treatment in an Israeli ICU

Abstract

Objective: To determine whether physicians in Israel withhold and/or withdraw life-sustaining treatments. Design: A prospective, descriptive study of consecutively admitted patients. Patients were prospectively evaluated for diagnoses, types and reasons for forgoing life-sustaining treatments, mortality and times from forgoing therapy until mortality. Setting: A general intensive care unit of a university hospital in Israel. Results: Forgoing life-sustaining treatment occurred in 52 (13.5%) of 385 patients admitted and 5 (1%) had cardiopulmonary resuscitation. Withholding therapy occurred in 48 patients. Four patients with brain death had all treatments withdrawn. No patient had antibiotics, nutrition or fluids withheld or withdrawn. Time from forgoing therapy until death was 2.9 ± 0.6 days. Thirty-one of 48 (65%) patients who had therapy withheld died within 48 h. Conclusions: Withholding life-prolonging treatments is common in an Israeli intensive care unit whereas withdrawing therapy is limited to brain dead patients. Terminal patients die soon after withholding, even if the therapy is not withdrawn. Withholding treatments should be an option for patients and professionals who object to withdrawing therapies.