If, after carefully reviewing the patient's medical condition and progress, the family and medical team agree that further treatment is not in the patient's best interest, a decision may be made to put limits on the treatment offered.
The decision to limit the treatment is individualized. For example, a decision may be made to continue to provide maximum medical support (including medications, ventilator therapy and dialysis), but to stop further treatment in the event that the patient's heart should stop beating on its own.
If the patient's heart should stop beating, the condition is called a "cardiac arrest". Treatment for a cardiac arrest includes pressing on the patients chest to restart the heart (called CPR), the use of powerful heart medications, the delivery of an electrical shock to the chest (called defibrillation) and/or the use of a pacemaker.
One of the first treatments that may be withheld is CPR. All other life-support can be continued after a decision to withhold CPR is made.
If the patient is not responding to life-support treatment, and is believed to have an irreversible disease, a decision may be made between the family and health care team to withhold any additional life-support. For example, we may continue with the level of medication and breathing support, but decide not to increase the therapy further.
If death or a very poor quality of life is expected to the be the outcome of the illness, a decision may be made to stop any new treatments and to actively stop the life-support measures that are currently in place. When a decision is made to withdraw life-support therapy, death often occurs within a short period of time.
If a decision is made to withdraw or withhold further treatment, the team will meet with the family to discuss how the family would like to say goodbye. The comfort of the patient is always the priority.
All decisions to limit treatment are made following careful consideration of the patients medical condition and following discussions with the patient or family.