Principles and practice of withdrawing life-sustaining treatments

The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life support occurs with the same quality and attention to detail as is routinely provided when life support is initiated. Approaching the withdrawal of life support as a medical procedure provides clinicians with a recognizable framework for their actions. Key steps in this process are identifying and communicating explicit shared goals for the process, approaching withdrawal of life-sustaining treatments asa medical procedure, and preparing protocols and materials to assure consistent care. Our hope is that adopting a more formal approach to this common procedure will improve the care of patients dying in intensive care units.