Withdrawal of treatment in the intensive care unit: the ethical and legal issues

Many articles have been written and studies conducted into why our patients' pain is not being managed more effectively. The myths and fears still persist, yet the solution is known. Why, then, can't our profession help those we care most about--our clients? Intensive care units (ICUs) have, over the last 30 years, become places of life-saving miracles, and as such, moral dilemmas have also been created. As early as 1976, applications have been made to courts for the withdrawal of life-sustaining treatment (Wallace, 1995). The decision to withdraw treatment is one faced by health professionals every day in the ICU, and there are many legal and ethical issues to consider. The emotional, and other, stakes are also high in this area for patient, family and care team. This paper discusses ethical and legal issues highlighting the principles, doctrines, legislation and precedents especially important in the making of the decisions to withdraw treatment. An ethical framework grid is suggested to assist with the decision-making process.