When to Withdraw or Withhold Treatment

by Duncan Vere

read : When to Withdraw or Withhold Treatment (Part 1)

When to Withhold

Treatments often carry risks, and a doctor needs to weigh up the balance between the potential for doing good and the potential for harm.

People who are refused antibiotics when they have a sore throat often feel let down, but the doctor has been weighing up the small chance of the drugs making any difference, against the very real risk that over-use of antibiotics can lead to resistant bacteria developing.

Deciding whether to place an artificial hip in a young person with bone disease is complicated. Most hip joints only last ten years,
so if the person is young he or she may need repeated operations. However, at the moment, the techniques used actually damage the bone, so that it is unlikely a surgeon would be able to perform the procedure more than twice. Delaying treatment for as long as possible may benefit the patient.

When a road accident victim arrives in a casualty department, staff have to work fast, but they must also assess whether it is appropriate to commence extreme measures to maintain the patient’s life, or whether intervention is inappropriate.

Sometimes a doctor may wish to withhold treatment because although the patient thinks he or she is ill, the doctor doesn’t agree and believes that any treatment could be harmful. On occasions, friends or family of a patient may ask for treatment out of misunderstanding or fear.

Respecting People

Christians base treatment decisions on the fundamental principle of respect for the sanctify of human life. This is not altered if a person is very old or very young, physically able or has severe disabilities. For example, a recent discussion document from the British Medical Association says that the association ‘finds unacceptable’ the practice whereby people with conditions like Down’s syndrome are unlikely to be offered life-sustaining procedures like organ transplants.

Where possible, people also have a right to make decisions about their own treatment. This includes the right to refuse any treatment even if that decision seems irrational. A person can write an ‘advance directive’ or ‘advance refusal’, which informs doctors and relatives about their likely opinion about treatment. These documents can be referred to if the person is no longer conscious.

Respecting people also means recognising their mortality. Over treating patients fails to respect that part of being human is to be mortal. It has also led to increasing demands for euthanasia, as people become frightened that they may be supported by medical technology beyond their ability to cope.

However, if there is any doubt about the best way to proceed, then treatments that prolong life should be continued.

Some reasons why a doctor may decide to avoid, delay, start or stop a particular treatment

it might help, but cause serious harm as wellthe treatment only works for a limited period and then becomes ineffective or damagingwhile it is uncertain whether the treatment will help, give it a try and be prepared to stop if it doesn't workit is harming more than helping
the nature of the illness is unclearsymptoms are transitory but may indicate disease, so keep tablets with you and take if the symptoms reappearthough unlikely to help, the patient may be one of a minority who could respond and the risk is smallthe patient asks for to stop
the patient is already getting betterthe patient is showing some signs of recovering, in which case wait. if the recovery does not continue then treatment could startit seems likely to help and risks are small compared to the likely benefitsthe patient is dying and the treatment is not one to ease suffering
the patient refuses treatmentit was an experimental treatment and has failed
there is no reason to think that it will helpthe patient is not showing any improvement after a reasonable amount of time

Read more: When to Withdraw or Withhold Treatment (Part 3)

Christian Medical Fellowship (CMF) Files No. 7, 1999