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Hospital Policy Variation in Addressing Decisions to Withhold and Withdraw Life-Sustaining Treatment.

Gina M Piscitello1, Patrick G Lyons2, Valerie Gutmann Koch3

  • 1Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA; Palliative Research Center, University of Pittsburgh, Pittsburgh, PA.

Chest
|January 6, 2024
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Summary

Most US hospitals have policies on withholding or withdrawing life-sustaining treatment, but these vary widely and rarely address sociodemographic disparities in decision-making.

Keywords:
clinical medical ethicshealth disparitieshospital policylife-sustaining treatment

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Area of Science:

  • Medical Ethics
  • Health Policy
  • Healthcare Disparities

Background:

  • Sociodemographic disparities influence physician decisions regarding life-sustaining treatment.
  • Limited understanding exists regarding hospital policies guiding these critical decisions.

Purpose of the Study:

  • Assess the prevalence of US hospital policies on withholding/withdrawing life-sustaining treatment.
  • Examine how these policies address ethically complex scenarios.
  • Investigate the inclusion of sociodemographic disparities in these policies.

Main Methods:

  • National cross-sectional survey of hospital policies.
  • Electronic distribution to the American Society for Bioethics and Humanities membership.
  • Descriptive analysis of policy content.

Main Results:

  • 92% of surveyed hospitals have policies on withholding/withdrawing life-sustaining treatment.
  • Policies permit withholding/withdrawal for patient/surrogate requests (82%), physiologic futility (81%), and potentially inappropriate treatment (64%).
  • Only 8% of policies addressed sociodemographic disparities, with conflicting recommendations; 3% recommended data collection for disparity identification.

Conclusions:

  • While most US hospitals have policies for life-sustaining treatment decisions, significant variation exists in criteria and processes.
  • These policies infrequently address sociodemographic disparities, indicating a gap in promoting equitable care.