Withholding and Withdrawing Treatment

Thanks to recent breakthroughs in medical science and technology, doctors now have available a variety of machines, devices and treatments to keep people alive when an important body system stops working properly. Examples include breathing machines, feeding tubes, CPR and dialysis machines. Even medicines like antibiotics sometimes serve as a life-sustaining treatment. These technologies can be true life-savers when used temporarily on a person who has a treatable condition and just needs some time to recover. But sometimes the person is not going to recover. They will never regain the ability to live without life-support. The person stays alive only because a machine or other treatment is doing the work that the body no longer can do.

Many people want no part of a life sustained only by medical technology. Some feel that the burdens of being attached to a machine outweigh the benefits. Perhaps they have other things they want to do with the time they have left. Perhaps they find the treatment dehumanizing or too uncomfortable. For some people, quality of life is more important than length of life. No one can be forced to start using or keep using a life-sustaining measure they do not want. When a person may, or has, become dependent on such a treatment, decisions may need to be made about whether to withhold or withdraw the treatment (not start it, or stop using it).

A patient who decides not to use life-sustaining treatment or who decides not to continue using a life-sustaining treatment is not “committing suicide.” Likewise, an agent who makes the same request on behalf of the patient is not “killing” the patient. If the person dies, the cause of death is the underlying illness, or in other words, “natural causes”.

It is important to understand that there is no moral, ethical or legal difference between deciding not to start a life-sustaining treatment and deciding to stop it after it has been started. In the past, people worried that if they started on a ventilator or a feeding tube, they would have to stay on it forever. That is not the case. A patient or their agent can tell the medical team to stop or not start a life-sustaining treatment at any time if this is not what the patient wants or would want.

For a more comprehensive discussion about making medical decisions, Making Medical Decisions for Someone Else: A Vermont Handbook is available for free download.