Decision tree. A process for determining when to withdraw or continue life-sustaining medical treatment

Whether to provide life-sustaining treatment for never-competent adult patients or formerly competent patients whose wishes are unknown is one of the most difficult decisions healthcare providers face. To help address this problem, in 1992 the National Center for State Courts published Guidelines for State Court Decision Making in Life-sustaining Medical Treatment Cases. The publication contains a decision tree to help judges determine whether decisions to continue or discontinue life-sustaining treatment is within the law. A modified version of the tree has been developed for members of the institutional ethics committee and other staff who consult on patient cases at St. John's Regional Health Center. Springfield, MO. The revised decision tree grew out of center staff's extensive experience in making life-sustaining medical treatment decisions and essentially reflects St. John's practice in this area. Persons who wish to use it should first run some of their own cases against the model to see if it fits their needs. They should also realize that no consensus exists in state laws regarding standards for making decisions in this area.