Witholding and Withdrawing Treatment

Intensive care:

• May improve both quality and quantity of life
• Can cause considerable suffering for both patients and families
• May be appropriate to withhold or withdraw when there is no potential benefit
  
  • This assessment is based on probability rather than certainty, and involves weighing:
    • Potential benefits of treatment
    • Burden of treatment
      • Pain
      • Suffering
      • Loss of dignity
    • Known views of the patient
      • Directly if competent
      • Via advanced directive, next-of-kin, or another confident if incompetent

Considerations

• There is no obligation to initiate or continue ineffective therapy
• The competent adult is entitled to withhold or withdraw consent for any treatment at any time, even if this may shorten their life
  Under these circumstances, the clinician has a responsibility to:
  • Assess competence
  • Provide all information required to fully inform decision
• Treatment limitation may be raised by:
  • The patient
  • Patient family and friends
    Weighed against what is known or inferred from patients wishes and values.
  • Healthcare professionals
• Basis and nature of treatment limitations should be documented
• Witholding and withdrawing treatment are legally and ethically equivalent, and the principles and processes used should be the same

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References

1. CICM & ANZICS. IC-14 Statement on Withholding and Withdrawing Treatment. 2021.