Decision making at the end of life often involves very difficult and emotive decisions. It could involve for example whether to start artificial feeding and hydration, or mechanical ventilation when someone is unable to manage on their own. Other decisions can be around whether to withdraw a treatment that has already been started. This may be if it is felt not to be helping or becoming too burdensome for very little gain – in other words affecting quality of life. 

Nurses are often involved in the debates surrounding the withholding or withdrawal of treatment and there are often conflicting views in decision making. Ethical and moral factors are enmeshed in these decisions and there are also sometimes worries about legal implications.

“Euthanasia and assisted suicide are different from withholding or withdrawing life-sustaining treatment in accordance with good medical practice by a medical practitioner. When treatment is withheld or withdrawn in these circumstances, and a patient subsequently dies, the law classifies the cause of death as the patient’s underlying condition and not the actions of others” (NSW Health: Guidelines for end-of-life care and decision-making).

Resources

• The truth about dying explores some end of life ethical concepts on an ABC radio show
• The Royal Children’s hospital Melbourne, has information on Withholding or Withdrawal of Life-Sustaining Treatment
• The Royal College of Paediatrics and Child Health (UK) has produced a document: Witholding or Withdrawing Life Sustaining Treatment in Children: A framework for Practice (May 2004)
• The International Association of Hospice and Palliative care IAHPC Manual of Palliative Care 2nd Edition has a section on Ethical Issues.
• The Center for Bioethics, University of Minnesota (US) has a document: End of Life Care: An Ethical Overview
• The Southern Cross Bioethics Institute website provides access to information on bioethical legislation in Australia, much of which is relevant to palliative care. It can be different in each State and Territory, such as the Consent to Medical Treatment and Palliative Care Act 1995 (SA) and the Medical Treatment Act 1994 (ACT).
• The General Medical Council in the UK has produced a guidance for doctors that may be of interest: Treatment and Care Towards the End of Life – Good practice in decision-making.

Related CareSearch pages

Nurses Hub
Communication
Advanced Care Planning
Working with Families
Symptom Management

Free Full Text Article

Slomka J. Withholding nutrition at the end of life: clinical and ethical issues. Cleve Clin J Med. 2003 Jun;70(6):548-52.

Young R, King A. Legal Aspects of Withdrawal of Therapy. Anaesth Intensive Care. 2003 Oct;31(5):501-8.

References

• Crawford D, Way C. Just because we can, should we? A discussion of treatment withdrawal. Paediatr Nurs. 2009 Feb;21(1):22-5. 
• Campbell ML. How to withdraw mechanical ventilation: a systematic review of the literature. AACN Adv Crit Care. 2007 Oct-Dec;18(4):397-403; quiz 344-5.
• Wiegand DL, Kalowes PG. Withdrawal of cardiac medications and devices. AACN Adv Crit Care. 2007 Oct-Dec;18(4):415-25.
• Andrews K. Clinical approaches to the withdrawal of nutrition and hydration. Clin Med. 2003 Jul-Aug;3(4):342-5.

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This page was created on 27 August 2010
Last updated 27 August 2010*