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Withdrawing may be preferable to withholding

By Jean-Louis Vincent


The majority of deaths on the intensive care unit now occur following a decision to limit life-sustaining therapy, and end-of-life decision making is an accepted and important part of modern intensive care medical practice. Such decisions can essentially take one of two forms: withdrawing – the removal of a therapy that has been started in an attempt to sustain life but is not, or is no longer, effective – and withholding – the decision not to make further therapeutic interventions. Despite wide agreement by Western ethicists that there is no ethical difference between these two approaches, these issues continue to generate considerable debate. In this article, I will provide arguments why, although the two actions are indeed ethically equivalent, withdrawing life-sustaining therapy may in fact be preferable to withholding

Topics: Commentary
Publisher: BioMed Central
Year: 2005
DOI identifier: 10.1186/cc3486
OAI identifier:
Provided by: PubMed Central

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  1. (2002). A four-step protocol for limitation of treatment in terminal care. An observational study in 475 intensive care unit patients. Intensive Care Med
  2. (1991). Am Rev Respir Dis
  3. Anonymous: Withholding and withdrawing life-sustaining therapy. This Official Statement of the American Thoracic Society was adopted by the ATS Board of Directors,
  4. (2001). Association: Withholding and Withdrawing Lifeprolonging Medical Treatment: Guidance for Decision-making.
  5. (2004). Can the experienced ICU physician predict ICU length of stay and outcome better than less experienced colleagues? Intensive Care Med
  6. (1999). Cohen S: ABC of intensive care. Withdrawal of treatment. BMJ
  7. (1993). Decisions near the end of life: professional views on life-sustaining treatments.
  8. (2001). End of life in intensive care [in French]. Réanimation
  9. (2004). FH: Limitation of life support: frequency and practice in a Hong Kong intensive care unit. Crit Care Med
  10. (1999). Forgoing life support in Western European intensive care units: The results of an ethical questionnaire. Crit Care Med
  11. (2004). Intensive Care Med
  12. (2004). JL: Analysis of terminal events in 109 successive deaths in a Belgian intensive care unit. Intensive Care Med
  13. (1998). JM: A national survey of end-of-life care for critically ill patients.
  14. (1997). JM: Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med
  15. (1991). Legal myths about terminating life support.
  16. (2004). Limiting life support: a world-wide consensus? Crit Care Med
  17. (1997). Nilstun T: The difference between withholding and withdrawing life-sustaining treatment. Intensive Care Med
  18. (1998). Sprung CL: Foregoing life-sustaining treatment in an Israeli ICU. Intensive Care Med
  19. (2005). Sprung CL: Withdrawing and withholding life sustaining therapies are not the same. Crit Care
  20. (2003). Tacchi EM: End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting. Intensive Care Med
  21. (1992). Withdrawing life-sustaining treatment: lessons from Nancy Cruzan. Arch Intern Med
  22. (1999). Withdrawing or withholding life prolonging treatment. BMJ
  23. (2001). Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group. Lancet

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