Withdrawing life support/ medical treatment in critically ill patients is a difficult decision that must be made by the patient's family, loved ones, medical team, and the patient if the patient is conscious. If the patient is unconscious or sedated with medication then the pre-written will or wish of the patient should be considered very seriously. It involves balancing the patient's quality of life with the potential for recovery, and ultimately determining when continued treatment is futile.
In most palliative care setups these patients will not be on ventilators or serious life-saving medications as we see commonly in a typical intensive care unit. In spite, we are frequently encountering requests from loved ones about withdrawing simple treatments such as oxygen, sugar, blood pressure medications, etc. Most of the loved ones get confused about removing life support and basic medical care. They sometimes get a poor understanding of the internet about sedation and quality of life.
As we are all aware these patients could have spent a lot of money in a hospital setup before they came to Palliative Care Nevertheless withdrawing a basic medical treatment should never be considered based on monetary calculations. Equally age discrimination is also ethically wrong, since a lot of our elderly people had simple stressful free healthy lifestyles in most of their life, so they can survive and come out faster from their illnesses with simple basic care.
Withdrawing basic care such as oxygen, cardiac medicine, and diuretics should never ever be done in an awake patient with end-stage cardiac disease or kidney disease. Withholding invasive and expensive treatment such as dialysis is perfectly justified if the entire team agrees. Holding any new treatments such as antibiotics or blood pressure-supporting medications can be agreed upon without any ethical dilemma.
Sedation and painkillers such as morphine can be considered only if the patient shows any sign of distress. In our palliative care set up most of these patients would have been treated outside and they could have established a personal bonding with a particular doctor, involving them if appropriate will make the decision easier. In some cases, the patient may be in a persistent vegetative state or serious brain damage and in a semi-conscious state but otherwise normal vital functions, In these cases refusing any basic treatment is probably equivalent to euthanasia which is illegal in most countries and in a proper hospital settings government guidelines are very strict.
If a particular patient the entire team decides to withdraw any treatment it should be done gradually starting with reducing the amount of support provided and monitoring the patient's response. This may involve reducing the amount of sedation given to the patient, allowing them to be more awake and responsive, or discontinuing certain medications. It is important to note that withdrawing life support does not necessarily mean that the patient will die immediately. In some cases, the patient may be able to continue living for a period of time without life support. The decision to withdraw life support should always be made with the patient's best interests in mind, and with the goal of ensuring that the patient is comfortable and not suffering. In this process, it is Paramount to make sure the patient should not feel any pain or discomfort.
It is also important that the medical team involved in the patient's care is aware of the patient's wishes and values. Advance directives, such as living wills and durable power of attorney for healthcare, can provide necessary guidance in these situations. These documents allow patients to express their wishes for medical treatment in the event that they become unable to make decisions for themselves. In the end, withdrawing life support is a difficult decision that requires careful consideration and compassion. It is important to remember that the patient's comfort, dignity, and quality of life should always be at the forefront of the decision-making process. The medical team, family, and loved ones should work together to ensure that the patient's wishes and values are respected and that the patient is not suffering.