title: Can curative or life-sustaining treatment be withheld or withdrawn? The opinions and views of Indian palliative-care nurses and physicians.
abstract: BACKGROUND
  Decisions to withdraw or withhold curative or life-sustaining treatment can have a huge impact on the symptoms which the palliative-care team has to control. Palliative-care patients and their relatives may also turn to palliative-care physicians and nurses for advice regarding these treatments. We wanted to assess Indian palliative-care nurses and physicians' attitudes towards withholding and withdrawal of curative or life-sustaining treatment.
  
  
  METHODS
  From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programmes in New Delhi, using a semi-structured questionnaire. For the interviews and analysis of the data we followed Grounded-Theory methodology.
  
  
  RESULTS
  Withholding a curative or life-sustaining treatment which may prolong a terminal cancer patient's life with a few weeks but also has severe side-effects was generally considered acceptable by the interviewees. The majority of the interviewees agreed that life-sustaining treatments can be withdrawn in a patient who is in an irreversible coma. The palliative-care physicians and nurses were of the opinion that a patient has the right to refuse life-saving curative treatment. While reflecting upon the ethical acceptability of withholding or withdrawal of curative or life-sustaining treatment, the physicians and nurses were concerned about the whole patient and other people who may be affected by the decision. They were convinced they can play an important advisory role in the decision-making process.
  
  
  CONCLUSIONS
  While deciding about the ethical issues, the physicians and nurses do not restrict their considerations to the physical aspects of the disease, but also reflect upon the complex wider consequences of the treatment decisions.
authors.affiliation: Interdisciplinary Centre for the Study of Religion and World View (Catholic University Leuven), Sint-Michielsstraat 4-Bus 3101, 3000, Leuven, Belgium. Joris.Gielen@theo.kuleuven.be
authors.forename: Joris
authors.initials: J
authors.lastname: Gielen
authors.forename: Sushma
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: Seema
authors.initials: S
authors.lastname: Mishra
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Chaturvedi
authors.forename: Harmala
authors.initials: H
authors.lastname: Gupta
authors.forename: Ambika
authors.initials: A
authors.lastname: Rajvanshi
authors.forename: Stef
authors.initials: S
authors.lastname: Van den Branden
authors.forename: Bert
authors.initials: B
authors.lastname: Broeckaert
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D007194:India; D008020:Life Support Care / Q000941:ethics*; D008297:Male; D010166:Palliative Care / Q000941:ethics*; D010820:Physicians / Q000941:ethics*; D016312:Treatment Refusal; D028761:Withholding Treatment / Q000941:ethics*