Sometimes a patient may request that a life-sustaining treatment or device be discontinued. Quill et al proposed guidelines to help a physician evaluate and respond to such a request. The authors are from the University of Rochester in New York.

Examples of life-sustaining treatments:

(1) implantable cardioverter defibrillator (ICD)

(2) dialysis

(3) mechanical ventilation


All of the following should be present before discontinuing a life-sustaining therapy:

(1) The request from the patient should be rational and consistent.

(2) Depression or other condition that might distort the patient's judgment should be identified. If present, then an attempt should be made to treat that disorder to see if the patient will alter his or her decision.

(3) The patient's condition must be fully understood, including its prognosis and probable course.

(4) Alternatives to discontinuation of therapy must be identified and disclosed to the patient.

(5) Specific plans should be made for continued care if the therapy is discontinued.

(6) A second opinion is obtained and concurs.



• For item 6 I would add that the patient be given time to reconsider.

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