withdrawing and witholding treatment (mini learning)

Question 1

When is withholding treatment a permissibile act?

Answer 1

When the treatment is medically duttile and will provide no overall benefit, but you must be certain this is the case !

Question 2

Does the law distinguish between withdrawing and withholding treatment ?

Answer 2

No they are seen as the same in the eye of the law, as they have very similar outcomes

Question 3

Does the law class withholding/withdrawing treatment as murder ?

Answer 3

No

Murder = an act primarily intending to cause death

Withdrawing/withholding = an act made when a patient cannot be further treated but will/may result in that patient’s death

Question 4

What type of euthanasia is ‘withholding/withdrawing treatment’ classed as ?

Answer 4

Non-voluntary passive euthanasia

Question 5

Which clinical treatments are eligible for withholding/withdrawing if not in the patients best interest ?

Question 6

Give some examples of treatment classed as ‘basic care’ …

Answer 6

basic rights and comfort

• food (solids/liquids)
• drink
• assisted eating (spoons, straws…)
• assistance in general
• hygiene
• pressure relief

Question 7

Give some examples of treatments classed as ‘clinical care’ …

Answer 7

medical help requiring specialist skills and equipment

• drips
• feeding tubes (NG, PEG, TPN)
• urinary catheterisation

Question 8

What would withholding basic care be classed as, in terms of the law ?

Answer 8

Neglect/negligence (or worse)

Question 9

What type of care is permissible to withhold/withdraw if the patient will not benefit from it ?

Answer 9

clinical care

not basic care, that would be ‘neglect’

Question 10

When might the distinction between withholding basic Vs clinical care be blurry ?

Answer 10

e.g when a patient cannot swallow, so ’basic care’ (e.g solid foods) could be harmful but ‘clinical care’ may have no overall benefit (e.g if patient is terminal and untreatable)

Question 11

At what point may withdrawing/withholding treatment be the right decision ?

Answer 11

if…
1. patient’s death is imminent
2. burden of the process is greater than the benefit (pain etc)

Question 12

Does ‘basic care’ continue even if ‘clinical care’ has been withheld/withdrawn ?

Answer 12

Yes, basic care continues until death

Question 13

What does the ‘code of practise’ state as confirmation of death ?

Answer 13

• 5mins of cardiorespiratory arrest

and

• absence of pupillary response to light
• absence of corneal reflex
• no motor response to supraorbital pressure

*added complexities if patient has been comatose or received drugs’