End-of-life care: challenges and obligations in setting limits to life-sustaining therapy

It is now generally accepted that the withholding or withdrawal of interventions that serve only to prolong the dying process is appropriate. Setting limits to life-sustaining therapy are now common practice. However, making such decisions can be challenging. They are also not uncommonly a source of disagreement between the physician and the patient or surrogate. The potential for strained patient-physician relationship can be mitigated by patient-centred, goal-specific care with its emphasis on effective communication, a sense of timing and attention to the various dimensions of the illness experience.