
Contents
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Introduction to withholding and withdrawing life-sustaining treatment Introduction to withholding and withdrawing life-sustaining treatment
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Consider the legal and ethical framework Consider the legal and ethical framework
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Is withholding/withdrawing LST legal? Is withholding/withdrawing LST legal?
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Withholding/withdrawing LST is not the same as physician-assisted suicide Withholding/withdrawing LST is not the same as physician-assisted suicide
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Withholding versus withdrawing LST Withholding versus withdrawing LST
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What are the ethical considerations? What are the ethical considerations?
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General principles of modern bioethics General principles of modern bioethics
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Beneficence/non-maleficence Beneficence/non-maleficence
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Autonomy Autonomy
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Justice Justice
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Other ethical considerations Other ethical considerations
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Proportionality Proportionality
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Extraordinary versus ordinary treatments Extraordinary versus ordinary treatments
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Futility Futility
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Non-abandonment Non-abandonment
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Double effect Double effect
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Protection of vulnerable patients Protection of vulnerable patients
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Assess the consequences of utilizing or forgoing life-sustaining treatment Assess the consequences of utilizing or forgoing life-sustaining treatment
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Assess decision-making capacity Assess decision-making capacity
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Make a decision regarding life-sustaining treatment Make a decision regarding life-sustaining treatment
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Shared decision-making: an introduction and some practical considerations Shared decision-making: an introduction and some practical considerations
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Advance directives Advance directives
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Surrogate decision-making Surrogate decision-making
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Resolving conflict Resolving conflict
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Withdrawing/withholding life-sustaining treatment Withdrawing/withholding life-sustaining treatment
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Notes on specific life-sustaining treatments Notes on specific life-sustaining treatments
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Cardiopulmonary resuscitation Cardiopulmonary resuscitation
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Background Background
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Outcomes of CPR Outcomes of CPR
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Discussing code status Discussing code status
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Patient with a do not resuscitate/do not intubate (DNR/DNI) order requiring operative or sedative procedures Patient with a do not resuscitate/do not intubate (DNR/DNI) order requiring operative or sedative procedures
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Mechanical ventilation Mechanical ventilation
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Cardiac and circulatory support Cardiac and circulatory support
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Haemodialysis Haemodialysis
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Artificial nutrition and hydration Artificial nutrition and hydration
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Antibiotics Antibiotics
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Withdrawal/withholding of LST in the setting of severe neurological impairment Withdrawal/withholding of LST in the setting of severe neurological impairment
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Conclusion Conclusion
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References References
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Online references Online references
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5.8 Withholding and withdrawing life-sustaining treatment (including artificial nutrition and hydration)
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Published:March 2015
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Abstract
Life-sustaining treatment (LST) is any treatment that serves to prolong life without reversing the underlying medical condition, and includes cardiopulmonary resuscitation, mechanical ventilation, haemodialysis, left ventricular assist devices, antibiotics, and artificial nutrition and hydration. The appropriate use of LST in seriously ill patients is a controversial topic that continues to generate intense debate amongst private citizens as well as health-care professionals, bioethicists, lawyers, governments, and religious institutions. This chapter sets out important questions clinicians ought to consider before making the decision to withhold or withdraw LST. This practical guide should enable clinicians to accurately identify the issues relevant to a given case and to make decisions that are both medically and ethically sound.
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