The Ethics of Withdrawal of Life Support: Research Paper

The act of withdrawal of life support and life-sustaining treatments is an ethical issue that has been highly debated across the globe. Many patients in ICU die due to the elimination of life support as well as the withholding of palliative care. Various medical interventions fail to be given to these patients with anticipation that they will lose their lives under their underlying illnesses. The proposers and opponents of this issue have distinct ideas about its ethicality. Withdrawal of life support is supported by various doctrines such as autonomy, non-maleficence, and beneficence. Health professionals are conversant with these philosophies, but they may not fully comprehend the legal requirement in their practices, and this may lead to a breach of the patient's medical consent. The decisions to end life support is initiated by the physicians and the patient's family (Lyu & Zhang, 2018). Medical teams make sure that the family is guided via the ideologies of informed consent and informed refusal before making the final decisions. The principles approve that the patient's family or surrogates may decline any or all remedies. This paper aims at covering the withdrawal of life and life-sustaining treatments to better understand the legal requirements in practice.

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In the United States, the laws that govern life-sustaining treatment differ in numerous states. The foremost idea of removal of life support was initially handled by the Supreme Court when dealing with Cruzan's situation. The parents wanted a feeding tube to be eradicated from a vegetative patient. Following the evidence provided, the Law Court recognized the standard that a proficient individual's liberty to forgo treatment, such as hydration and nutrition, was authorization attention that was indicated under the Fourteenth Amendment to the Constitution. The authority permitted the extraction of life support of the patient following the standard of informed refusal, but it failed in addressing the futility notion. The idea of futility may be interpreted in different ways by the physicians, and it is not easily understood by the patients' families and surrogates (Welie & Ten Have, 2014a). In most instances, health professionals recognize the futility in applauding that life support to be foregone. Many doctors have, in different cases, singly withheld or introverted life support they discovered to be ineffective without consulting the patients' families or despite their oppositions.

Treatment withdrawal is individualized, depending on the patients' health conditions in the intensive care unit (Welie & Ten Have, 2014a). Patients who are mainly subjected to the withdrawal of life support are those whose health conditions continue deteriorating despite aggressive best therapy. Such patients are likely to die regardless of whether the treatment is stopped or continued. Qualitative reasons can also trigger physicians to consider withdrawing the life support of patients. Some patients can have an overwhelmingly poor neurological outcome that results in a coma despite the quality treatment that is administered.

Additionally, critically ill patients experience functional disability, such as post-hypoxic brain injury and recovery, become almost impossible. In such cases, healthcare providers may consider withholding life-sustaining treatments under the patient's and family members' consent. Another condition that can make doctors believe treatment withdrawal is lethal conditions. Patients may experience severe systemic illnesses such as metastatic malignancy, which prolong survival chances.

The applications of autonomy, non-maleficence, and beneficence principles can be confusing to health providers who are not fully conversant with laws that are governing the withdrawal of life support. Having a rigid foundation and comprehension of these values play a vital function in incapacitating ethical dilemmas related to who should make the decisions in withdrawing treatment (Lyu & Zhang, 2018). The beneficence principle aims at supporting actions that could yield physiological or psychological benefit for the patients and their family members or other people around them. Any treatment is considered to have a real advantage if it enhances the patients' health conditions. Providing life-sustaining measures to prolong patients' lives could be a distressing experience for the patients because the patients' would be expected to tolerate the pain for an unknown period.

Additionally, the physicians would be required to maintain the services offered without causing further deterioration. Many health care professionals would prefer administering palliative care to active treatment. The current treatment of the patients could be painful, but the withdrawal of the procedure could be more destructive to the patients. In such a case, the beneficence principle could be better exercised through supporting the patients' therapies since they would produce more good than harm. Above all, patients' treatment wishes must be respected.

Physicians and nurses have a significant role in managing terminal injuries and monitoring the patients' treatment processes until their recovery. The reality of death is typically hard for patients and their families (ANA Center for Ethics and Human Rights, 2016). Therefore, health professionals should focus on attaining a quality standard of primary palliative care and employ adequate knowledge in improving the patients' care. Most importantly, the nurses should acquire advanced skills in recognizing and monitoring the patients' symptoms such as pain, constipation, dyspnea, and nausea. Additionally, the nurses should cooperate with the care groups to help in ensuring that the patients and their families access exact information about the likelihood of imminent death.

Before the end of life is initiated, the healthcare professionals must have exceptional familiarity with the pathophysiology of acute sickness. The care providers are expected to create clinical selections for the patient based on this knowledge. In this perspective, clinical decision-making is founded on the physiologic outcomes of the patients' conditions. Physicians must consider whether the goal of treating the patients is to cure, help patients in living appropriately without serious illnesses, know whether the patient is likely to die from the disease and identify whether the patients should know their needs can be accomplished. All the alternatives that no longer help the patients should be eradicated, and all the decision making processes should incorporate important targeted questions. Nonetheless, the primary focus of the health providers should be on the goals of care, such as identifying whether vasopressors would help to boost the patients' lives.

According to Lyu & Zhang (2018), poor prognosis of acute ailments signifies unlikely prolonged survival. Physicians should conduct proper administration of medication to patients to manage the effect of the diseases and be able to discover strange changes within the patients' bodies. In the end-stage of an ailment such as cardiopulmonary disease, most patients experience discomfort, and care providers must carefully monitor their conditions and adjust healthcare services where necessary. Nonetheless, patients should be assumed that they can fight and recover from any illness until proved otherwise. In case patients' capacities are impaired, caregivers should provide them all the necessary support for maximizing their ability to retain information provided to reach accurate decisions.

In some instances, the patients do not deserve the withdraw of life support. Instead, they require suitable intercessions for treatment and reduction of pain where there is still optimism and the likelihood of survival (Shah, 2014). The best approach in helping a patient whose life seems to terminate is to attempt different intermediation processes, and try experimental courses of actions instead of forgoing life-sustaining treatments (Welie & Ten Have, 2014b). In situations where the procedures are extraordinary a burden to the patients and their families, physicians may decide that withholding and withdrawal of life-sustaining treatments are ethical and humane (Eijkhjolt, 2013). Consequently, if the demise process is likely to be extensive and painful, physicians are expected to apply the removal of life support to help the patient to pass away in peace and dignity.

Health professionals should be given significant support in conducting end of life care on patients who are very vulnerable and without any hope of survival. This would be significant in preventing the patients' families from using resources that will not benefit the patients. Also, health care institutions should be at the forefront in communicating with the patients' family members on the need to stop health services that cannot support the patients' survival instead of causing a severe depletion of family resources. The caregivers should also be able to give valid explanations as to why services such as organ transplantation, CPR, and chemotherapy cannot boost the survival of the patients to help understand the patients' health scenarios.

The fact that foregoing life-support therapies is legitimately vindicated if support epitomizes unwelcome treatment it requires to be withdrawn under the consent of the patients or members of the families. Doctors may, at a time, recommend bound treatment on futility. Still, this idea is not required to be invoked at any time to eradicate support in the absence of the patients' awareness over their objections. Moreover, regardless of whether the physicians are practicing in health centers that have established futility regulations, they should acknowledge that these rules function mainly as aspects for strengthening mutual decision-making among care providers, surrogates, and patients, but not elements for reinforcing results initiated by doctors separately. Lastly, doctors can forego life-support for vulnerable patients who are unable to make healthy choices and have no surrogates. However, the physicians involved in making the decisions on behalf of the patients should act like formal surrogates and provide the services that the patients would want to be offered. The caregivers should exercise what they believe would be the patients' best interests.

Another critical aspect that the attending medical doctors require to know is that withholding and withdrawing of life support as well as administering palliative care incorporate other practitioners. Therefore, a conducive working environment needs to be created to support all the planned activities towards boosting the patients' health condition. Escalated disagreements among the healthcare officials on the goals of care is likely to upsurge the jeopardy of liability. All practitioners performing in palliative care should deliver maximum comfort to the patients with a minimum of aggressive interferences. The family members or surrogates should be consulted for any contribution that they might be having. All health measures that are observed not to be relieving suffering but hastening death should be circumvented. Most patients lose their lives in 24 hours when life-sustaining treatments are introverted (Lyu & Zhang, 2018).

Nonetheless, for others, the dying procedure might take many days. Whatever period is needed for demise to happen, the analgesic processes started should be determined by goal expressions of patient agony when possible. In this regard, caregivers can inquire for sedatives and analgesics to be used by patients who would benefit from them.

The principles of law, which govern every state show that citizens possess a right to de...