Withdrawing and Withholding of Medical Treatment

This paper is a literature review discussing the withdrawing and withholding of medical treatment in adult intensive care (ICU).

This paper discusses that withholding and withdrawing treatment appears to be more acceptable to physicians than that of shortening life. The author defines “withholding treatment” as the decision either not to start or not to increase treatments that may sustain life, while “withdrawing treatment” is defined as removing a life-sustaining intervention that is being used on a patient; “active shortening” of the dying process is an act specifically performed to end life, such as an intentional overdose, which is not “active euthanasia” because most ICU patients can not actively participate in the decision. The paper points out that the role of law is to articulate the minimum standards that professionals must achieve in the care of patients.

Table of Contents
Geographical Perspective
Ethics and Legal Considerations
Law and the Withholding or Withdrawal of Care
Physicians Personal Perspective
“For example, in the United States, the care of patients at the end of their lives has become care that actively involves the patient, or if the patient is unable to participate in the decision making process, those family members who hold power of attorney to make such decisions for them. In North America, there is a trend toward earlier abandonment of life sustaining therapies. In Europe, active euthanasia is common in the Netherlands and Belgium although it is practiced legally in only one European country. The overall incidence of the withdrawal of life sustaining measures in European ICUs is not known, although withholding and withdrawing life support is actively used by most European intensivists, shortening of the dying process remains rare.”