Withholding or Withdrawing Treatment

Suicidal ideation and attempted suicide are important presenting complaints in the emergency department (ED). The juxtaposition of a self-inflicted gunshot wound and self-reported no code status may serve to amplify the moral distress of attending emergency providers. Imagine caring for a terminal yet capable patient, who independently attempts suicide unsuccessfully and is brought to the ED with an advance directive (AD) requesting no treatment. The exceptional consideration in this suicidal context is whether the treatment can be effective. In a case with a very low likelihood that any intervention could produce a good outcome, clinical judgment becomes the basis for withholding or withdrawing treatment, not the AD.

Download Full-text

An Alternative Perspective on Rationing Ventilators

Ethics & Medics ◽

10.5840/em20204576 ◽

2020 ◽

Vol 45 (7) ◽

pp. 5-6

Author(s):

Tadeusz Pacholczyk ◽

Keyword(s):

Health Care Professionals ◽

Clinical Status ◽

Ethics Committees ◽

Withdrawing Treatment ◽

Medical Decisions ◽

Psychological Strain ◽

Exclusion Criteria ◽

Scarce Resources ◽

Alternative Perspective ◽

Withholding Or Withdrawing Treatment

The COVID-19 pandemic has resulted in discussion on how to allocate scarce medical resources such as ventilators. Some bioethicists have suggested that difficult determinations about withholding or withdrawing treatment should be made by triage officers or committees to alleviate the psychological strain on frontline clinicians. However, this raises concerns about shifting important personal medical decisions away from physicians and their patients. According to the principle of subsidiarity, frontline clinicians, together with their patients, should be making these decisions, with ethics committees or triage committees serving only in an advisory capacity. Several ethical principles can help health care professionals allocate scarce resources. These include basing exclusion criteria on clinical status rather than nonmedical characteristics; randomizing treatment for clinically similar patients; obtaining free and informed consent when considering the withdrawal of treatment, even in situations where treatment is possibly futile; and emphasizing quality palliative care for all patients.

Download Full-text

Ethical Dilemmas in Postnatal Treatment of Severe Congenital Hydrocephalus

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180115000316 ◽

2016 ◽

Vol 25 (1) ◽

pp. 84-92 ◽

Cited By ~ 1

Author(s):

DOMINIC WILKINSON

Keyword(s):

Ethical Dilemmas ◽

Best Interests ◽

Congenital Hydrocephalus ◽

Limited Resources ◽

Withdrawing Treatment ◽

Term Survival ◽

Postnatal Treatment ◽

The Brain ◽

Withholding Or Withdrawing Treatment

Abstract:Severe congenital hydrocephalus manifests as accumulation of a large amount of excess fluid in the brain. It is a paradigmatic example of a condition in which diagnosis is relatively straightforward and long-term survival is usually associated with severe disability. It might be thought that, should parents agree, palliative care and limitation of treatment would be clearly permissible on the basis of the best interests of the infant. However, severe congenital hydrocephalus illustrates some of the neuroethical challenges in pediatrics. The permissibility of withholding or withdrawing treatment is limited by uncertainty in prognosis and the possibility of “palliative harm.” Conversely, although there are some situations in which treatment is contrary to the interests of the child, or unreasonable on the grounds of limited resources, acute surgical treatment of hydrocephalus rarely falls into that category.

Download Full-text