Case Study 21 : WITHHOLDING LIFE SUPPORT
Challenges
Patient is a 56 y/o female admitted because of difficulty of breathing. She was diagnosed with infiltrating Ductal Cell carcinoma for 3 years, and recently, with advanced pulmonary metastasis with a rapidly deteriorating condition. The doctors inform her any major intervention would most probably be of no use at this stage. Two days later she opts to refuse surgery should her condition worsen.
Question
Is withholding life support acceptable from the ethical point of view? If so, under what circumstances?
Solutions
Withholding treatment of terminally ill patients is an acceptable option in certain cases: when the doctors deem that there is no reasonable hope for recovery, or when the burden (whether to the patient, the family or society) is too much. Such treatment procedures are considered ethically extraordinary (even though they might be medically ordinary), and may therefore be forgone. Note that these same two criteria guide decisions about whether to withdraw treatment already initiated or not.
The doctors have given up hope for recovery, even with surgery. Assuming that the patient’s decision was made freely and was well-informed (as to the procedures, anticipated risks and benefits, alternative procedures, and hoped-for results, and taking into account family plans, allocation of scarce resources and needs of other patients), her desire not to be operated on must be respected.
The case presented affords some luxury of time. The patient, the family and the medical team were able to discuss and reflect on the situation. On the other hand, emergency cases oftentimes present a quite different scenario. One is usually unable to examine the patient sufficiently to determine the chances for recovery, or to know how much burden the procedures would impose on the family. One needs to decide right away whether to operate or not, or to intubate or not. What, then, should the physicians do?
When in doubt, the best course tends towards saving lives, i.e., to intervene. If a later judgment deems the procedure (e.g., intubation) unnecessary after all (i.e., if there is very little or almost no hope for recovery, or if the burden is too great), one may then contemplate on the possibility of withdrawing life support.
