oa South African Journal of Bioethics and Law - Withholding and withdrawing treatment : practical applications of ethical principles in end-of-life care



Consideration of withholding or withdrawing treatment as a sound clinical decision developed as a consequence of the availability of advanced medical technology and the resultant ability to prolong life that in some cases is in fact unwanted prolongation of the dying process. This prolongation of life may occur without allowing for patient perspectives such as quality of life, being close to family members at a critical stage of life, and the implications of provision of end-of-life care in the alien environment of the hospital or intensive care unit.

Many people fear the process of dying rather than the fact of dying. This fear is often associated with interventions that may be undertaken at the end of life as well as with the knowledge that suffering may be a part of dying and that both may be associated with loss of dignity of the individual.
The paper discusses the statement that withholding or withdrawing treatment can be considered a sound clinical decision when reached in discussion with the patient (if competent), the family and the clinical care team. This decision is not taken lightly and it may not be easy to reach consensus on the decision. It is therefore important that the discussion and decision making are based on established bioethical principles.


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