Delicate Debate Urged Over Withdrawal of Life Support

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Withdrawal took more than one day for almost half of the patients. These patients tended to be younger, had stayed longer in the ICU, had experienced more life-sustaining interventions, were less likely to have cancer, and had more people involved in decision-making. They were on four life-support systems, on average, in the days before their death, ranging from mechanical ventilation to feeding tubes, the study found.

Extubation (removing ventilator tubes) before death was linked with higher family satisfaction.

"My take on these data is that when life support is removed gradually, physicians don't bring families along -- they're not speaking to families enough as they're making the decisions," Curtis said. "Physicians often take several days to make up their own mind. Families need to be brought along, then it takes several more days. Withdrawing slowly gives the family time to catch up, but if they're involved earlier that wouldn't be necessary."

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Smythe added: "If you look across past studies, one of the things that is always brought up is dissatisfaction with communication with physicians. My concern is that stuttering withdrawal of care is a surrogate for physicians not having good communication with patients... You'd be surprised, probably 80 percent of the time, if you're very clear about the consequences of not withdrawing care, families don't want that."

More information

Visit the U.S. National Cancer Institute for more on end-of-life issues.

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