title: The Durban World Congress Ethics Round Table Conference Report: I. Differences between withholding and withdrawing life-sustaining treatments.
abstract: BACKGROUND
  Withholding life-sustaining treatments (WHLST) and withdrawing life-sustaining treatments (WDLST) occur in most intensive care units (ICUs) around the world to varying degrees.
  
  
  METHODS
  Speakers from invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress in 2013 with an interest in ethics were approached to participate in an ethics round table. Participants were asked if they agreed with the statement "There is no moral difference between withholding and withdrawing a mechanical ventilator." Differences between WHLST and WDLST were discussed. Official statements relating to WHLST and WDLST from intensive care societies, professional bodies, and government statements were sourced, documented, and compared.
  
  
  RESULTS
  Sixteen respondents stated that there was no moral difference between withholding or withdrawing a mechanical ventilator, 2 were neutral, and 4 stated that there was a difference. Most ethicists and medical organizations state that there is no moral difference between WHLST and WDLST. A review of guidelines noted that all but 1 of 29 considered WHLST and WDLST as ethically or legally equivalent.
  
  
  CONCLUSIONS
  Most respondents, practicing intensivists, stated that there is no difference between WHLST and WDLST, supporting most ethicists and professional organizations. A minority of physicians still do not accept their equivalency.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. Electronic address: charless@ekmd.huji.ac.il.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.affiliation: Division of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Fathima
authors.initials: F
authors.lastname: Paruk
authors.affiliation: Department of Pediatrics and Emergency Medicine, Children's Hospital and Sunny Hill Health Centre for Children, University British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Center for Sepsis Control and Care, Jena, Germany.
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
authors.affiliation: Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital and The University of Queensland, Herston, Queensland, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.affiliation: Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.affiliation: School of Child and Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Argent
authors.affiliation: Department of Anaesthesia and Critical Care, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal eThekwini-Durban, KwaZulu-Natal, South Africa.
authors.forename: R Eric
authors.initials: RE
authors.lastname: Hodgson
authors.affiliation: Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
mesh_terms: D001291:Attitude of Health Personnel; D026688:Bioethical Issues; D003226:Congresses as Topic; D003422:Critical Care / Q000941:ethics*; D006801:Humans; D008020:Life Support Care / Q000941:ethics; D009014:Morals; D012121:Respiration, Artificial / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*
keywords: Ethics; Law; Life-sustaining treatments; Withdrawing; Withholding