Withdrawing/Withholding Life Support: Pros and Cons

When a person is being sustained by life support, families and loved ones are frequently confronted with the resolve about when to terminate these supports (Meeker, 2012). Recently it has turned into “pulling the plug” prior to death regardless of the tubes and machines keeping the patient alive. Withdrawal choices are informal and quietly decided. If these life-ending decisions were standardized and validated, maybe some of these safety measures can be useful to other choices approaching the idea of drawing life to a close, even for those who aren’t dependent on life-supports (Meeker, 2012). As we advance towards the twenty first century, it will become more common for us to be supported by equipment and medications the last few days or weeks of our lives. If some disease or condition that would, as a rule, take months or even years to bring death, the need for life-support could be longer. “Withdrawing life-sustaining treatment such as artificial ventilation means to discontinue it after it has been started. Withholding life-sustaining treatment means never starting it,” (Fremgen, 2012). If in fact we are being kept alive by any form of medical equipment, any choices made about the best time to die and the best means to allow our deaths should contain queries about what to do with the life-support systems in place, sustaining life (Lin, 2003).

Withdraw/Withhold Life Support: Pros and Cons
Ending Life-Supports: A Well-Established Medical Procedure
Ethics in medicine in the twenty first century contains ceasing life-supports. Certain end-of-life choices consist of never commencing life-supports once it is well-defined that starting the patient on a ventilator will only lengthen the method of dying (Lotto, 2012). Loved ones involved in this end-of-life decision will probably decide not to prolong the process of dying (Efstathiou, 2011). Reasonable people usually agree that if there is to be no recovery and the life-support merely prevents further deterioration, then it is pointless to keep them on life-supports for an indefinite period of time (Meeker, 2012). On the flipside, when a person is close to their inevitable demise, they might have some very significant things to accomplish before the end (Lotto, 2012). For instance, we may have religious reasons or farewells that we want to complete before nature taking its course is permitted. In some cases, amends want to be made, sins forgiven and the chance to be able to see family and loved ones before death. Various Ways of “Pulling the Plug” Are More Debated

“Pulling the plug” on life-support systems is not as stigmatic as taking a lethal chemical to bring death. Each individual, being of sound mind and body, should have the right to decide on their own lives (Lotto, 2012). Life in an intensive care unit is in no way similar to the life lived up to this point. If we live long enough, we will most likely be using various medications at the end of our lives. Continual adjustments to counteract side-effects, controlled by another drug with side-effects and then another drug to control those particular side-effects, and so on, it becomes a viscous cycle. In this situation, we can refuse to take any of the drugs that keep us alive. Also, at the end-of-life, we may not be able to eat and a feeding tube may be considered. This decision should not be taken lightly. All the implications for everyone involved needs to be considered. From a medical point of view, continuing artificial nutrition and hydration is a common means by which our life ends (Lin, 2003). Such decisions should be put into our Advance Directives for Medical Care. Safeguarding to Premature Withdrawal of Life-Supports

We as the patients need protection from mistakes and abuses of any protocol that allows withdrawal of life-support systems. Occasionally harmful decisions are being made without consideration of all options. One’s own view on life and death should form our end-of-life choices. Everyone has different beliefs and values used throughout our lifetime (Lin, 2003). Some of our principles form the basis for our own medical ethics. Ethics committees are available in hospitals and nursing homes that might be able to offer wise advice to the legal deciders, ourselves and/or appointed proxies (Lin, 2003). Pros and cons can be presented to such committees by the patient. Laws are also in place as another layer of protection and means of enforcing them so that those who cannot protect themselves can be saved from others who mean harm. Maybe laws are needed to regularize the withdrawal of life-supports. Any such provisions could be included in new laws against causing premature death (Hov, 2010).

Since We Can Be Reasonable About “Pulling The Plug”,
Perhaps The Same Decision-Making Process
Can Be Applied To Other Life-Ending Decisions

As more experience is gained with ending life-supports, people will become familiarized with the safeguards that should be in place to make sure the patient isn’t harmed any less than the harm already being imposed by the life-support systems themselves. Out of most deaths occurring in hospitals, an overwhelming amount involves important elements of choice. If no choices are made, the patient will be maintained on life-support until they die in spite of the tubes and machines. “Treated-to-death” is sometimes the interpretation of standard medical care. Our culture has not shown much attention to life-ending decisions (Hov, 2010). If over half of deaths in America include choices, then there is already over a million life-ending decisions a year.

Implied safeguards are widely used for these medical decisions today. Safeguards can be more implicit as people are more aware of medical decisions that bring death, and keeping an eye on other life-ending decisions about terminating life-support, it will not be in complete control of the doctors. We are learning how to put into words these safeguards that perhaps should be realistic to all life-ending decisions. Rather it involves the belief that human life is inviolable and that we have the duty to respect one of the most relevant aspects of the biological life, that is, self-preservation. In this respect, life has an ‘‘intrinsic’’ value that transcends every other characterization in terms of quality of life or social interactions” (Lotto, 2012). The right-to-die means being able to make intelligent decisions so that we may die at the best possible time by the best means.

References

Efstathiou, N., & Clifford, C. (2012). The critical care nurse’s role in End-of-Life care: issues and challenges. Nursing In Critical Care, 16(3), 116-123.
Fremgen, Bonnie F., Fourth Edition, (2012). Medical Law and Ethics, 13, 322-344.
Hov, R., Hedelin, B., & Athlin, E. (2010). Being an intensive care nurse related to questions of withholding or withdrawing curative treatment. Journal Of Clinical Nursing, 16(1), 203-211.
Lin, R. J. (2003). Withdrawing life-sustaining medical treatment—A physician’s personal reflection. Mental Retardation & Developmental Disabilities Research Reviews, 9(1), 10-15.
Lotto, L., Manfrinati, A., Rigoni, D., Rumiati, R., Sartori, G., & Birbaumer, N. (2012). Attitudes Towards End-of-Life Decisions and the Subjective Concepts of Consciousness: An Empirical Analysis. Plos ONE, 7(2), 1-5.

Meeker, M., & Jezewski, M. (2012). Metasynthesis: withdrawing life-sustaining treatments: the experience of family decision-makers. Journal of Clinical Nursing, 18(2), 163-173.