The sequence of withdrawing life-sustaining treatment from patients

Am J Med. 1999 Aug;107(2):153-6. doi: 10.1016/s0002-9343(99)00198-9.


Purpose: To describe the observed sequence of withdrawal of eight different forms of life-sustaining treatment and to determine whether aspects of those treatments determine the order of withdrawal.

Subjects and methods: We observed 211 consecutive patients dying in four midwestern US hospitals from whom at least one of eight specific life-sustaining treatments was or could have been withdrawn. We used a parametric statistical technique to explain the order of withdrawal based on selected characteristics of the forms of life support, including cost, scarcity, and discomfort.

Results: The eight forms of life support were withdrawn in a distinct sequence. From earliest to latest, the order was blood products, hemodialysis, vasopressors, mechanical ventilation, total parenteral nutrition, antibiotics, intravenous fluids, and tube feedings (P <0.0001). The sequence was almost identical to that observed in a previous study based on hypothetical scenarios. Forms of life support that were perceived as more artificial, scarce, or expensive were withdrawn earlier.

Conclusion: The preference for withdrawing some forms of life-sustaining treatments more than others is associated with intrinsic characteristics of these treatments. Once the decision has been made to forgo life-sustaining treatment, the process remains complex and appears to target many different goals simultaneously.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Decision Making
  • Female
  • Health Care Rationing
  • Hospitals, Community
  • Hospitals, University
  • Humans
  • Life Support Care / economics
  • Life Support Care / standards*
  • Male
  • Medical Futility*
  • Middle Aged
  • Minnesota
  • Missouri
  • Terminal Care / economics
  • Terminal Care / standards*
  • Withholding Treatment*