Withdrawing and withholding of treatment in the intensive therapy unit : ethical issues

Abstract

The advancement of medical technology throughout the last few years has given rise to a wide variety of medical treatment and interventions for acute and chronic illnesses. It has also given the ability to change the path of natural death, giving rise to numerous ethical issues when it comes to decision making in end of life care. Withdrawing and withholding of treatment are two ways which are considered to be easiest and a legal way to safeguard patients from end of life suffering and prolongation of life through futile treatment administration, as euthanasia is still illegal in the majority of EU countries. The provision of medical care and comfort is just as important as aggressive treatment. Although there is a medical difference between withdrawing and withholding of treatment, there is no moral difference between the two as long as the patient’s autonomy rights and values are safeguarded throughout the process. In the majority of ITU cases where such decisions need to be taken the patients are incapable to contribute to such decision making on their health plans, and hence this responsibility befalls on the relatives causing it to be a stressful and emotional roller coaster. To be able to safeguard the values and wishes of dying patients the author of this thesis will suggest and justify the introduction of Advance Directives (ADs). During such circumstances, provision of care to dying patients and relatives can be also considered as stressful and overwhelming. Nurses here have the important role of acting as ethical advocates/caregivers to help ease the transition to end of life care and also help relatives understand their care plan. This leads to the importance of virtue ethics as the approach to take when one needs to exercise rational control over emotions.