Worldwide similarities and differences in the foregoing of life-sustaining treatments

Foregoing life-sustaining treatment in an Israeli ICU

OBJECTIVE

To determine whether physicians in Israel withhold and/or withdraw life-sustaining treatments.

DESIGN

A prospective, descriptive study of consecutively admitted patients. Patients were prospectively evaluated for diagnoses, types and reasons for foregoing life-sustaining treatment, mortality and times from foregoing therapy until mortality.

SETTING

A general intensive care unit of a university hospital in Israel.

RESULTS

Foregoing life-sustaining treatment occurred in 52 (13.5%) of 385 patients admitted and 5 (1%) had cardiopulmonary resuscitation. Withholding therapy occurred in 48 patients. Four patients with brain death had all treatments withdrawn. No patient had antibiotics, nutrition or fluids withheld or withdrawn. Time from foregoing therapy until death was 2.9 +/- 0.6 days. Thirty-one of 48 (65%) patients who had therapy withheld died within 48 h.

CONCLUSIONS

Withholding life-prolonging treatments is common in an Israeli intensive care unit whereas withdrawing therapy is limited to brain dead patients. Terminal patients die soon after withholding, even if the therapy is not withdrawn. Withholding treatments should be an option for patients and professionals who object to withdrawing therapies.

International perspectives on ethics in critical care

Differences in culture, resources, demand, level of development, and cultural and religious differences may alter ethical approaches around the world. The principles of medical ethics are beneficence, nonmaleficence, autonomy, disclosure of information, and social justice. Difficult decisions as to whom to admit and whom to exclude are faced by physicians internationally. Differences between countries are seen in the withdrawal and withholding of treatments and in the obtaining of informed consent in emergency circumstances.