Withhold Or Withdrawing Life Sustaining Measures

The decision of when to withdraw life support or whether to begin life-sustaining treatments for your loved one is complicated with ethical issues and strong emotions. People are faced with the decision to withhold or withdraw life support every day—but it’s never easy.

Hero Images / Getty ImagesLife-sustaining treatment, also known as life support, is any treatment intended to prolong life without curing or reversing the underlying medical condition. This can include mechanical ventilation, artificial nutrition, hydration, kidney dialysis, chemotherapy, and antibiotics.

Quality vs. Quantity of Life
Advances in medicine and technology are helping people to have longer, healthier lives. These advances in medical technology are not only helping people live longer, but they help to prolong the lives of people who couldn’t sustain life on their own. This raises the debate over quality vs. quantity of life.

Ethical questions include:

* Are we helping people live longer at the expense of their comfort and dignity?
* If we don’t use artificial means to support life, are we denying them the chance to live longer or recover fully?
* What if a miracle happens while they are on life support and they are cured?
* What if we take them off life support and they find a cure shortly after they die?

Who Can Make Life Support Decisions?
The American Medical Association’s Code of Medical Ethics states that “a competent, adult patient, may, in advance, formulate and provide a valid consent to the withholding and withdrawing of life-support systems in the event that injury or illness renders that individual incompetent to make such a decision.”

The decision about who is responsible for life support decisions can be determined in advance:

How to Make the Decision
If you find yourself or someone you love faced with this decision, the most important thing you can do is evaluate your own goals and the known wishes, if any, of the patient. If you are the designated healthcare surrogate, you may have already had a conversation about the patient’s wishes.

Tips to consider if you are the one responsible for making the decision:

* Gather all the information you can about the types of life-sustaining measures the patient requires, including the benefits and risks of each one.
* Review the patient’s end-of-life documents, if they have any.

If there is no legal document to refer to and you have not had conversations about life-sustaining treatments with the patient, the decision can be more difficult to make.

Discussions With Family and Friends
Consider gathering all close relatives and perhaps very close friends to discuss what the patient would have wanted.

Each family member will have their own unique experiences with the patient to draw on, so a family decision can be filled with a range of emotions and a variety of opinions.

Potential outcomes of a family discussion:

* It is best when all the patient’s loved ones can agree on whether to withhold or withdraw life support. When the medical situation clearly points in a certain direction, this is more likely.
* If a unanimous decision can’t be made, it may be helpful to try mediation. A social worker or chaplain can often help mediate difficult situations like these.

The decision will ultimately fall to the designated or default surrogate, but if all the patient’s loved ones can participate in the decision-making process, it can help foster closer relationships and prevent resentment (and lawsuits).

After the Decision Is Made
Making an informed decision, even when taking into consideration the benefits, risks, and what you feel the patient would have wanted for him/herself, can still cause feelings of guilt and uncertainty. Consider getting some emotional support during and especially after making the decision.

Talk with a professional counselor, a member of the clergy, or even a good friend to get those feelings out in the open and begin to deal with them. Check with your local hospice agency to find support groups for people who have gone or are going through the same thing. And lastly, give yourself a break. You can only make the decision you feel is best at the time, and you should move forward knowing that you did the best you could for your loved one.