Published ahead of print on March 22, 2007, doi:10.1164/rccm.200609-1397CP Am. J. Respir. Crit. Care Med., Volume 175, Number 11, June 2007, 1104-1108 A more recent version of this article appeared on June 1, 2007
Submitted on September 30, 2006 The Pressure to Withhold or Withdraw Life-Sustaining Therapy From Critically Ill PatientsJohn M Luce1* and Douglas B White21 Department of Medicine, San Francisco General Hospital, San Francisco, CA, USA, 2 Department of Medicine, University of California, San Francisco, CA, USA * To whom correspondence should be addressed. E-mail: john.luce{at}sfdph.org.
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, withhholding and withdrawing life-sustaining therapy, ICU rationing, triage
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