Foregoing life support in medically futile patients.
Advances in medical technology have rendered the ability to provide prolonged physiologic support of incurable or terminally ill patients commonplace in the intensive care unit. In tandem, there has been a global shift in the intensivist's mindset from solely pursuing an unrelenting course of aggressive therapy, to a recognition of the limitations of intensive care and the appropriate discontinuance of nonbeneficial therapy. Underpinning this shift remains the physician's adherence to the ethical principles of beneficence, nonmaleficence, and disclosure; the patient's right to autonomy and self determination; and the community's right to just distribution of medical resources. When the doctor assumes the role of patient advocate, and assesses illness severity and evaluate recovery, or lack of, to a quality consistent with the patient's own life philosophy, he is able to communicate to the family a course of action that is in the patient's best interest. A consensus on withholding or withdrawal of care is often then achieved. The process of foregoing or withdrawing life-sustaining therapy itself, must be carried out with sensitivity and empathy, with the primary goal of providing comfort and reducing suffering.
Department of General Medicine, Tan Tock Seng Hospital, Singapore. dessmon_tai_yh@notes.ttsh.gov.sg
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D016638:Critical Illness / Q000628:therapy*; D004992:Ethics, Medical; D005065:Euthanasia; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000379:methods*; D018447:Medical Futility; D016414:Resuscitation Orders; D012297:Right to Die; D012846:Singapore; D017236:Suicide, Assisted; D016312:Treatment Refusal