Withdrawing Life-Sustaining Treatment in the Intensive Care Unit

Abstract

Although the withdrawal of life-support is increasingly common and currently may account for the majority of deaths in ICUs, practical aspects of this procedure have received little attention in the medical literature or in clinical training. Now that an ethical and legal consensus is forming on the process surrounding the decision to limit life-support, we must turn our collective research and educational skills toward improving the delivery of this care. Further research is necessary on optimal sedation regimens, palliative nursing care in critically ill patients, devices to assist communication and pain detection in intubated patients, and outcomes to measure the quality of death. Teaching "Withdrawing life-support" should take a place in the critical care curriculum next to sessions on "Airway management" and "Central venous catheterization." The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life-support occurs with the same quality and attention to detail as is routinely provided when life-support is initiated. Approaching the withdrawal of life-support as a medical procedure provides clinicians with a recognizable framework for their actions. A key step in this process is identifying explicit shared goals for the process. Our hope is that adopting a formal approach to this common procedure will improve the care of patients dying in hospitals.