In numerous legal cases, courts have found that it is equally justifiable to withdraw as to withhold life-sustaining treatments. While there is a natural tendency to believe this, there is no ethical distinction between withholding and withdrawing treatment. Many clinicians feel that it is easier to not start (withhold) a treatment, such as mechanical ventilation, than to stop (withdraw) it. In such a case, it would be justifiable to withdraw mechanical ventilation.ĭo different standards apply to withholding and withdrawing care? All that continuation would achieve in such a case is maintenance of biologic function. For example, patients with severe head trauma judged to have no chance for recovery of brain function can no longer benefit from being maintained on a mechanical ventilator.

In general, these goals are to cure if possible, or to palliate symptoms, prevent disease or disease complications, or improve functional status.

In some cases, the treatment may be 'futile' that is, it may no longer fulfill any of the goals of medicine. How do I know if the treatment is no longer 'of benefit?' Treatment withdrawal is also justifiable if the treatment no longer offers benefit to the patient. If the patient has the ability to make decisions, fully understands the consequences of their decision, and states they no longer want a treatment, it is justifiable to withdraw the treatment. When is it justifiable to discontinue life-sustaining treatments? In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. Examples include dialysis for acute or chronic renal failure and mechanical ventilation for respiratory failure. On the medicine wards, you will have patients who are receiving treatments or interventions that keep them alive, and you will face the decision to discontinue these treatments.

Is it justifiable to withhold or withdraw care because of costs?.

Is it justifiable to withhold or withdraw food or fluids?.

Does depression or other history of mental illness mean a patient has impaired decision making capacity?.

Is a psychiatry consult required to determine decision making capacity?.

What if I'm not sure if the patient is competent?.

Do patients have to be terminally ill to refuse treatment?.

Do different standards apply to withholding and withdrawing care?.

How do I know if the treatment is no longer 'of benefit?'.

When is it justifiable to discontinue life-sustaining treatments?.

Project Director, Bioethics Education Projectįaculty, Departments of Medicine and Bioethics and HumanitiesĬore clerkship material for: Internal Medicine of Bioethics & Humanities is in the process of updating all Ethics in Medicine articles for attentiveness to the issues of equity, diversity, and inclusion. Integrating relevant material from law and policy, the course will explore assumptions that underlie palliative care principles and values as they interface with cultural and ethnic values of patients and families.NOTE: The UW Dept. This course engages a discussion of the integration of ethical principles in medical care and decision-making in the context of psychosocial, spiritual and cultural aspects of the lives of patients and families. System Requirements: Attendees will need access to a computer with working camera and microphone. All courses are offered using Zoom conferencing software. Target Audience: Social workers and other social service providers working in palliative care.Ĭourse Delivery Method, Format and Instructor Interaction: Live interactive webinar with discussion. Instructor will use lecture, large group discussion and clinical case discussion. Attendees are visible to one another in Zoom meeting and are encouraged to be active participants with their camera and/or microphone in order take part in discussion. Login information will be emailed to all program participants a week before the fall and spring sessions. Instructor: Terry Altilio, LCSW, APHSW-C and Barbara A.

Ethical issues in end of life decisions