The Durban World Congress Ethics Round Table Conference Report: I. Differences between withholding and withdrawing life-sustaining treatments

• Published in: Journal of critical care 2014-12, Vol.29 (6), p.890-895
• Main Authors: Sprung, Charles L., MD, MCCM, FCCP, Paruk, Fathima, MBChB, FCOG(SA), PhD, Kissoon, Niranjan, MD, Hartog, Christiane S., MD, Lipman, Jeffrey, MBBCh, DA, FFA (Crit Care), FCICM, MD, Du, Bin, MD, Argent, Andrew, MBBCh, FCPaeds(SA), MD, Hodgson, R. Eric, FCA(SA), Guidet, Bertrand, MD, Groeneveld, A.B. Johan, MD, PhD, FCCP, FCCM, Feldman, Charles, MB, BCh, DSc, PhD, FRCP, FCP (SA)
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Bioethical Issues; Cardiopulmonary resuscitation; Congresses as Topic; CPR; Critical Care; Critical Care - ethics; Ethics; Humans; Intensive care; Law; Life Support Care - ethics; Life support systems; Life-sustaining treatments; Medicine; Morals; Palliative care; Patients; Pediatrics; Respiration, Artificial - ethics; Ventilation; Withdrawing; Withholding; Withholding Treatment - ethics
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.06.022

Abstract Introduction 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.