Withdrawal of Life Support

[deleted877019]

Just out of curiosity, I wanted to know:

Is withdrawal of life-sustaining treatment legal in the U.S.?

It isn't in some countries.

It IS, in the UK, where it is entirely the doctor's decision based on the patient's best interests or the understanding of it, though family are invariably explained things so that they're on the same page as the doctor.

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[Psai]

It should be mandatory, or even better yet we should never allow moribund people to start in the first place.

 

[Raryn]

Just out of curiosity, I wanted to know:

Is withdrawal of life-sustaining treatment legal in the U.S.?

It isn't in some countries.

It IS, in the UK, where it is entirely the doctor's decision based on the patient's best interests or the understanding of it, though family are invariably explained things so that they're on the same page as the doctor.

Certainly legal.

Generally speaking, it's done after a family meeting where you get them to agree it's what the patient would have wanted or that they understand that further care won't lead to a meaningful recovery.

A physician can theoretically declare that further care is futile and order it without familial consent, but most hospitals have explicit policies on what circumstances this can be done in. Typically would go through an ethics committee or similar, just for liabilities sake.

 

[deleted877019]

I'm referring to withdrawal, for example, extubation, and not to non-escalation or DNAR; the latter two I think would be OK in all countries.

 

[xffan624]

I'm referring to withdrawal, for example, extubation, and not to non-escalation or DNAR; the latter two I think would be OK in all countries.

Withdrawal of care including extubation is certainly legal in the US and is done in the situations that @Raryn described.

 

[Perrotfish]

I'm referring to withdrawal, for example, extubation, and not to non-escalation or DNAR; the latter two I think would be OK in all countries.

In the US discontinuation of life sustaing treatment is considered equivalent to not initiating treatment. It's always ok in consenting adults and in some cases OK in children with consenting parents (and who themselves consent, if they have the capacity to do so). There is no situation I can think of where it would be OK not to initiate treatment but where it would be illegal to discontinue it once initiated.

In the US the wishes of the patient, or their proxy if the patient is comatose and had left no written wishes, always supercede the judgement of the physician when it comes to life sustaining treatment. You can try to convince the family member that care is cruel and unlikely to end well, but you can't make them discontinue it unless you can (this rare) argue that it is completely futile.

 

[AdmiralChz]

I'm referring to withdrawal, for example, extubation, and not to non-escalation or DNAR; the latter two I think would be OK in all countries.

I'm confused, of course withdrawal of care is legal for the reasons above. What are you really trying to ask here? Why do I have a feeling it's sort of morbid or sketchy...

 

[deleted877019]

I
In the US the wishes of the patient, or their proxy if the patient is comatose and had left no written wishes, always supercede the judgement of the physician when it comes to life sustaining treatment.

Ok, that's good to know.

 

[deleted877019]

I'm confused, of course withdrawal of care is legal for the reasons above. What are you really trying to ask here? Why do I have a feeling it's sort of morbid or sketchy...

Morbid, yes. Sketchy? - I think the distinction among the scenarios is lucid.

 

[rokshana]

I'm referring to withdrawal, for example, extubation, and not to non-escalation or DNAR; the latter two I think would be OK in all countries.

i believe rayrn answered the question

 

[Raryn]

I'm referring to withdrawal, for example, extubation, and not to non-escalation or DNAR; the latter two I think would be OK in all countries.

Extubation and cessation of life-sustaining therapy is exactly what I was discussing. As it was stated above, deescelation is legally the exact same situation as choosing not to escalate care in the first place.

 

[austintr]

Not to mention, this happens at least dozens of times a day across the country and is part of providing competent, compassionate care. Not everyone wants to spend 5 years in a persistent vegetative state in a LTAC.

 

[deleted877019]

The question is definitely answered and thank you for that.

Slight surprise to note the inability to distinguish between non-escalation (not the same as de-escalation) and withdrawal, but I suppose if withdrawal is legal, the distinction may not be important, and that's why the little confusion in some posts about my question.

Edit: I think an example maybe appropriate.

Bad multiorgan failure, let's say, lactate 16 on CVVHDF, insanely high-inotropes, ischemic hepatitis, mottling... done everything, given every chance at survival.

Non-escalation: won't go above 1 mcg of norad.
Withdrawal: Press stop on infusion pumps and extubate.

Just to illustrate the distinction.

Like I said, my question is answered. Appreciate all responses. Thanks.

 

[hamstergang]

Slight surprise to note the inability to distinguish between non-escalation (not the same as de-escalation) and withdrawal

Nobody in this thread, as far as I can tell, had any difficulty in making this distinction. I think you just read the posts incorrectly.

 

[Precedexed Out]

Why would withdrawal of life-sustaining treatment be illegal? It depends on the patient wishes.

Withdrawing life-sustaining treatment is not equivalent to doing certain things to speed up a patents death. The latter is often illegal. The "doctrine of double effect' can be thought of the middle ground and an exception.

 

[AMEHigh]

In the U.S. patients have autonomy. So if their wishes are to have life sustaining treatment withdrawn then that's what happens, it's certainly not illegal.

If the patients wishes aren't known, they don't have a decision maker or guardian then it varies by state. The last state I was in 2 attendings had to make the decision.