Abstract
Objectives: First, to present the position on the distinction between withholding and withdrawing life-sustaining treatment as expressed in guidelines and examine its relation to the attitudes of health care professionals. Second, to examine the possible ethical justification of this distinction.
Design, setting, and participants: Critical analysis of guidelines on life-sustaining treatment and questionnaire administered to 148 health care professionals — physicians and nurses at the intensive care unit (ICU), University Hospital MAS, Malmö, Sweden.
Results: In contrast to the guidelines, which emphasize that there is no ethical difference between withholding and withdrawing life-sustaining treatment, not less than 50 per cent of the professionals in the ICU were of the opinion that there is an ethical difference. All attempts to justify this difference with reference to an inherent distinction between withholding and withdrawing seem to be controversial.
Conclusions: We recommend a change in emphasis in professional guidelines. Such guidelines should avoid the controversial issue about the possible inherent ethical difference between withholding and withdrawing life-sustaining treatment. What should be underlined is that the particular situation and the consequences of withholding as well as withdrawing life-sustaining treatment should always be taken into account.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
The Hastings Center (1987) Guidelines on the termination of life-sustaining treatment and the care of the dying. Indiana University Press, Bloomingdale, pp 4–6
Executive Board, American Academy of Neurology (1989) Position of the American Academy of Neurology on certain aspects of the care and management of the persistent vegetative state patient. Neurology 39: 25–26
Society of Critical Care Medicine (SCCM) Ethics Tasks Force (1990) Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill. Crit Care Med 18: 1435–1439
An ACCP/SCCM Consensus Panel (1990) Ethical and moral guidelines for the initiation, continuation, and withdrawal of intensive care. Chest 97: 949–958
American Thoracic Society (1991) Withholding and withdrawing life-sustaining therapy. Am J Respir Crit Care Med 144: 726–731
The World Federation of Societies of Intensive and Critical Care Medicine (1992) Declaration of the Council of the World Federation of Societies of Intensive and Critical Care Medicine. Intensive Crit Care Digest 11: 40–41
Svenska Läkaresällskapets delegation for medicinsk etik (1991) När får läkare avstå från behandling? Etiska riktlinjer (When may doctors forego treatment? Ethical guidelines). Printed 1996, In: Ottosson JO (ed) Värden i vården (Values in care) (in Swedish). Spri, Stockholm pp 29–32
Socialstyrelsens allmänna råd 1992: 2 (1992) Livsuppehållande åtgärder i livets slutskede (Life support in final stage) (in Swedish). Socialstyrelsen, Stockholm
The Appleton International Conference (1992) Developing guidelines for decision to forgo life-prolonging medical treatment. J Med Ethics [Suppl] 18
Emergency Cardiac Care Committee and Subcommittees, American Heart Association (1992) Guidelines for cardiopulmonary resuscitation and emergency cardiac care, VIII: ethical considerations in resuscitation. JAMA 268: 2282–2288
American Academy of Pediatrics, Committee on Bioethics (1994) Guidelines on forgoing life-sustaining medical treatment. Pediatrics 93: 532–536
Sprung C (1990) Changing attitudes and practices in forgoing life-sustaining treatments. JAMA 263: 2211–2215
Hull RT (1992) Withholding and withdrawing life-sustaining therapy. Ethical considerations. Am J Respir Crit Care Med 145: 249–250
Klocke RA (1992) Withholding and withdrawing life-sustaining therapy. Am J Respir Crit Care Med 145: 251–252
Solomon MZ et al (1993) Decisions near the end of life; professional view on life-sustaining treatments. Am J Public Health 83: 14–23
Sulmasy DP, Sugarman J (1994) Are withholding and withdrawing therapy always morally equivalent? J Med Ethics 20: 218–222
Gillon R (1994) Withholding and withdrawing life-prolonging treatmentmoral implications of a thought experiment. J Med Ethics 20: 203–204, 222
Harris J (1994) Are withholding and withdrawing therapy always morally equivalent? A reply to Sulmasy and Sugarman. J Med Ethics 20: 223–224
Iserson KV (1996) Withholding and withdrawing medical treatment: an emergency medicine perspective. Ann Emerg Med 28: 51–54
Sprung CL, Eidelman LA, Pizov R (1996) Changes in forgoing life-sustaining treatment in the United States: concern for the future. Mayo Clin Proc 71: 512–516
The Society of Critical Care Medicine Ethics Committe (1992) Attitudes of critical care medicine professionals concerning forgoing life-sustaining treatment. Crit Care Med 20: 320–326
Cugliari AM, Miller TE (1994) Moral and religious objections by hospitals to withholding and withdrawing life-sustaining treatment. J Community Health 19: 87–100
Weir RF (1989) Abating treatment with critically ill patients. Ethical and legal limits to the medical prolongation of life. Oxford University Press, New York
Beauchamp TL, Childress JF (1994) Principles of biomédical ethics, 4th edn. Oxford University Press, New York
Caralis PV, Hammond JS (1992) Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment. Crit Care Med 20: 683–690
Fried TR, Stein M, O’Sullivan P, Brock DW, Novack DH (1993) Limits of patients’ autonomy. Physicians’ attitudes and practices regarding life-sustaining treatment and euthanasia Arch Intern Med 153: 722–728
Faber-Langerdoen K (1994) The clinical management of dying patients receiving mechanical ventilation. A survey of clinical practice. Chest 106: 880–888
Edwards P (ed) (1967) The encyclopedia of philosophy. Macmillan and The Free Press, New York
Becker LC, Becker CB (eds) (1992) Encyclopedia of ethics. St James Press, Chicago London
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Melltorp, G., Nilstun, T. The difference between withholding and withdrawing life-sustaining treatment. Intensive Care Med 23, 1264–1267 (1997). https://doi.org/10.1007/s001340050496
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s001340050496