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The Pressure to Withhold or Withdraw Life-sustaining Therapy from Critically Ill Patients in the United States

¹ Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, and ² University of California, San Francisco, California

Correspondence and requests for reprints should be addressed to John M. Luce, M.D., Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Room 5 K1, San Francisco, CA 94110. E-mail: john.luce{at}sfdph.org

ABSTRACT

Physicians and nurses sometimes exert pressure on the families of critically ill patients to withhold or withdraw life-sustaining therapy from them. This pressure may stem from prognostic, professional, social, and economic factors. Although the pressure to limit life support may be appropriate in some circumstances, in others it is not justified. The pressure also may damage communications and cause resentment. If communications cannot be improved, and if the pressure cannot be relieved, a due process approach to conflict resolution that involves other parties may be required.

Key Words: end-of-life care • withholding and withdrawal of life-sustaining therapy • ICU rationing • triage

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