[Withholding and withdrawing therapy--how does the physician make a decision?]

Area of Science:

• Medical Ethics
• End-of-Life Care
• Patient Autonomy

Context:

• Withholding or withdrawing therapy presents significant ethical and practical challenges in medical care.
• Patients, particularly during end-of-life care, often lack the capacity for informed consent regarding treatment decisions.
• German legal recommendations favor "living wills" to document patient wishes for medical treatment when incapacitated.

Purpose:

• To explore the complexities surrounding decisions to withhold or withdraw medical therapy.
• To analyze the limitations of "living wills" and prognostic accuracy in end-of-life scenarios.
• To discuss the role of medical teams and legal frameworks in managing these critical decisions.

Summary:

• Accurate prognosis prediction for terminally ill patients is exceptionally difficult, even with advanced scoring systems.
• Subjective appraisal of prognosis and the applicability of living wills by the medical team are paramount.
• Decisions often result from internal debate; if living wills are absent, exploring patient wishes through relatives is necessary.

Impact:

• Highlights the near impossibility of precise prognostication in critical care, emphasizing reliance on clinical judgment.
• Clarifies that in Germany, withholding/withdrawing therapy is legally considered passive euthanasia and is permissible.
• Suggests withholding therapy escalation temporarily as a strategy to facilitate consensus among medical teams and relatives.