The ethics of hastening death during terminal weaning

Abstract

The process and, therefore, the timing of dying is open to manipulation by intensivists, families, other hospital physicians, courts of law and extraneous influences such as organ donation. Intensivists faced with these challenging processes need to consider some key principles to help them navigate the management of dying. They need to demonstrate transparency in order to engender trust, be responsive to the dynamically evolving needs of patient and family, avoid ambiguity, show consistency and predictability and, finally, they need to conform with society's expectations and professional standards to achieve defensibility for their actions. Adherence to these principles is likely to minimize conflict, maximize patient benefit, maintain public confidence and avoid professional jeopardy.

Palliation, end-of-life care and burns; practical issues, spiritual care and care of the family – A narrative review II

“…It has replaced the term terminal sedation, because the latter implied that the goal was to shorten life [ 28 ]. Nevertheless, palliative sedation remains a controversial area in palliative medicine, because it is here that the boundaries with euthanasia are close and not always clear [ 29 ]. Ten Have and Welie [ 30 ] devoted an interesting study to this.…”

“…In LMIC settings this brings us back to the clinician's responsibilities in the context of limited resources that have been discussed in the previous article. Informed consent from the patient or the family should be sought before initiating palliative sedation [ 29 ].…”

The Standardization Approach in End-of-Life Withdrawal of Life-Sustaining Treatment

“…There is a tremendous interest in terminal withdrawal of life-sustaining treatment (LST) and active shortening of endof-life trajectory to increase the pool of potential donors of transplantable organs in the intensive care unit (ICU). 1 Acute circulatory arrest and the loss of arterial pulse must develop within 2 hours after withdrawal of LST for successful nonheart-beating donation (controlled donation after circulatory death). 2 Withdrawal of therapeutically effective LST has been integrated as the standard practice in end-of-life care (EOLC), despite the absence of evidence for its safety.…”