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Discontinuing treatment of the critically ill patient 

Discontinuing treatment of the critically ill patient

Chapter:
Discontinuing treatment of the critically ill patient
Author(s):

M.J. Lindop

DOI:
10.1093/med/9780199204854.003.1708
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date: 30 March 2017

A patient may have made an advance directive before the moment of decision about life-prolonging treatments, and their view is paramount. However, many patients have not made such a directive, and in this circumstance the responsibility for such decisions remains with the doctor.

Most people agree that prolongation of life itself is not necessarily a benefit: it is only valuable if that life is of adequate quality. Continuing aggressive treatment of a patient who is severely ill may not be kind or sensible.

Depending on the clinical situation, it may be appropriate to decide not to escalate treatment, not to attempt cardiopulmonary resuscitation in the event of circulatory arrest, or to withdraw treatment. Key points in management in such circumstances are: (1) early anticipation of possible outcomes (2) continuing review of whether treatments remain beneficial (3) establishment of local guidelines for limiting or withdrawing treatment (4) good communication with the patient (where possible), family, and health team (5) clear documentation of decisions

Once a decision to withdraw treatment is made, then a drug or a feeding regimen can simply be stopped, and an intermittent therapy such as haemofiltration can be omitted. Terminal weaning is a protocol that allows death with dignity as mechanical ventilation is discontinued without causing distress to the patient or the family and carers.

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