The Need for Transparency when Withholding or Withdrawing Life Sustaining Treatment
The salient ethical and moral principle applicable to physicians’ responsibilities in following a patient’s rejection of artificial life sustaining treatment is the transparency of the conduct of all physicians, medical staff and fundamental understanding by the family and or friends as to what is being done and how it is being done.
It must be kept in mind that the distinguishing factor between terminal withdrawal or withholding of artificial life sustaining treatment and euthanasia is the patient’s rejection of treatment, either directly or through a properly informed surrogate, of artificial life sustaining treatment. Unambiguous documentation must set forth all discussion between the patient or surrogate, and physicians, nurses, bioethicists, social services and family members.
It must be clear that no physician or medical staff is “assisting” in the ending the patient’s life, but rather following the patient's decision. Only by being forthright about these factors can real transparency exist.
It is the fundamental right of all patients to reject medical treatment after all risks have been explained and all options presented and intelligently understood. The withdrawal or withholding of artificial life sustaining treatment requires the highest level of inquiry and caution.
Terminal withdrawal or withholding of artificial life sustaining treatment should only be carried out after a collective decision-making process. It should be discussed by a multidisciplinary group including: Primary Treating Physician, consulting physicians, Bioethisist; Social Worker, Nursing Director of Critical Care; and Nurses involved in the patient’s care.
If possible, a 24-hour period should pass from the time of the decision to the time of actual terminal withdrawal or withholding of artificial life sustaining treatment. If a surrogate has made the decision, the surrogate must review, understand and sign a form requesting a withdrawal and withholding of treatment.
It is the primary obligation of a patient’s primary treating physician to assure full communication and documentation. The primary treating physician may delegate this duty to the consultant primarily responsible for the care of the patient.
