[Withholding and withdrawing treatment, ethical and legal aspects].
BACKGROUND
In the wake of medical progress an important ethical discussion has arisen about when to withhold and when to withdraw life-sustaining treatment.


METHODS
Literature on withholding and withdrawing life-sustaining treatment was assembled and analyzed, and common norms were compared with Norwegian legal regulations.


RESULTS
Withholding or withdrawing life-sustaining treatment is not unusual when the treatment is regarded as futile. As opposed to euthanasia, limiting treatment is under certain circumstances legal. Core values--such as respect for the value of human life, the duty to save lives, equality, respect for patient autonomy, dignified death and professional integrity--may be given diverging emphases and interpretations. In many cases, the patient's capacity to consent is reduced, and it can be challenging to determine what is in the patient's best interest and when the treatment is futile. Good decision making processes and communication at the end of life is demanding, but may reduce and prevent many difficulties.


CONCLUSIONS
Norwegian healthcare legislation provides relatively little and to some extent unclear guidance on withholding and withdrawing life-sustaining treatment. National guidelines have not been developed. More attention could be paid to systematic approaches and dialogue with patients, relatives and all healthcare professionals about these issues.
Pedersen
Reidar
R
Seksjon for medisinsk etikk, Universitetet i Oslo, Postboks 1130 Blindern, 0318 Oslo. reidar.pedersen@medisin.uio.no
Bahus
Marianne Klungland
MK
Kvisle
Erik Martinsen
EM
D003142:Communication; D003657:Decision Making; D006801:Humans; D008020:Life Support Care / Q000941:ethics / Q000331:legislation & jurisprudence; D018447:Medical Futility / Q000941:ethics / Q000331:legislation & jurisprudence; D009664:Norway; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence; D026684:Personal Autonomy; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics; D011368:Professional-Family Relations / Q000941:ethics; D016414:Resuscitation Orders / Q000941:ethics / Q000331:legislation & jurisprudence; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence; D026712:Value of Life; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence