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Withdrawal of life-sustaining therapy

Jericho, Barbara, G.

Current Opinion in Anaesthesiology: April 2018 - Volume 31 - Issue 2 - p 179–184
doi: 10.1097/ACO.0000000000000570
ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum
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Purpose of review The aim of this review is to examine literature relating to the withdrawal of life-sustaining therapy (WLST).

Recent findings Discussions regarding end-of-life issues in adults and children are not occurring comprehensively. Discussions relating to the WLST in the pediatric population varies by institution and may vary by race, age, health insurance, diagnosis, and severity of illness. Completing advance directives prior to placement of life-sustaining treatments is not consistent practice. With the WLST, differences in perspectives exist between medical specialties, within one specialty at different levels of training, and in physicians’ ethical and psychological responses to the WLST. The timing of WLST appears to be influenced by ICU strain and communication issues. Study outcomes differ regarding the functionally favorable survival of patients who have had WLST. Universal guidelines for the WLST may not address individual patient circumstances.

Summary Discussions of end-of-life issues early in the course of a patient's health care will contribute to the healthcare team's understanding and respect of the patient's wishes. This article addresses the withdrawal of left ventricular assist devices; attending physicians and physicians in training perspectives of WLST; do physicians distinguish between withholding and WLST; the timing of WLST; guidelines for the process of WLST; and pediatrics and end-of-life decisions.

Professor of Clinical Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA

Correspondence to Barbara G. Jericho, MD, FASA, Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, 1740 W. Taylor Street, Suite 3200, M\C 515, Chicago, IL 60612, USA. Tel: +1 312 996 4020; e-mail: jericho@uic.edu

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