There may come a point in time when we realize that a patient is too ill to survive or that the quality of the patient's recovery would not be considered acceptable to the patient. If continued life-support is not be in keeping with the patient's best interests or prior expressed wishes, the treatment goals should be reviewed. Either the medical team or the patient's family may initiate a meeting to review the patient's treatment plan.In the event that the patient is capable of participating in a discussion, the patient is the decision-maker.
The decision to move away from aggressive treatment is individualized for each situation. The patient's medical condition, current level of life-support and patient and family wishes are all considered. A decision may be made to continue the current treatment plan, but to not offer anything new. This would be an example of withholding life-support. Alternatively, a decision may be made to stop all or some life-support treatments. This is called withdrawal of life-support.
When a decision is made to withdraw life-sustaining treatments, the plan of care shifts toward preparing the patient and family to say goodbye. Regardless of the treatment plan that is selected, patient's comfort is always the priority
The term "cardiac arrest" means "the heart has stopped beating". Death has taken place when a person's heart stops beating. Cardiac Arrest is a term used to describe a situation where the heart suddenly and unexpectedly stops beating. Attempts to bring the person back to life can be made by performing Cardio Pulmonary Resuscitation (CPR). CPR requires rapid and forceful compressions of the chest in the hopes that blood can be forced to circulate. Powerful medication is required to try to raise the blood pressure or stop erratic heart rhythms. Electrical shock may need to be delivered to the chest (called defibrillation) or a pacemaker may be attempted.
The success of CPR depends upon many factors. The most serious complication of cardiac arrest is brain damage. Other organs of the body can also be damaged while the heart has stopped or during CPR. Patients can suffer rib fractures, bleeding and pain. Patients with preexisting health problems are less likely to do well after CPR. If a patient was already on maximum life-support at the time of the cardiac arrest, their chance of a good recovery is quite low. Withholding CPR is often the first limit placed on care.
All decisions to withhold or withdraw active treatment are made after careful consideration of the patients medical condition, previous health status and patient values and beliefs. .
Last Reviewed: October 26, 2018
