Forgoing life-sustaining treatment in intensive care units. Practice, attitudes and ethics

Abstract: Many deaths in intensive care units are preceded by decisions to withhold or withdraw life-sustaining treatment. Under what conditions are forgoing life-sustaining treatment considered appropiate, when is it optitional and when is it wrong? Relevant guidelines are essential to help medical decisionmakers, but they cannot be established only from medical knowledge. They also must be related to basic values in the society. Different persons affected by the decision should have the opportunity to influence the guidelines. Their attitudes and the guidelines ought to be in concordance. However, surveys on attitudes to forgoing life-sustaining treatment cannot be used as a basis for recommendations without value premises. The results from a questionnaire to 148 medical professionals in an intensive care unit showed, that 50 percent were of the opinion, that there is an ethical relevant difference between withholding and withdrawing life-sustaining treatment. Guidelines state, that there is no such difference. It is better to avoid comparison in this manner. Both withholding and withdrawing can be either ethically right or wrong. Also chronological age, as a criterion when to forgo life-sustaining treatment, has been discussed. The indicated discrepancy between the official discrepancy and the professionals attitudes is not acceptable. In the intensive care unit, most critically ill patients have no capacity to decide themselves ablut forgoing life-sustaining treatment. The result from interviews with relatives to 16 patients, who recently had died in the intensive care unit, indicate, that the relatives want mutual communication and possibility to influence the decision. But they do not want to be responsible for the decision. Perhaps the family should not decide if this also means shared responsibility.