Decision-making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective

A new study in Chest documents the characteristics of intensive care unit (ICU) patients with a decision to withhold/withdraw life-sustaining treatment, including the types of supportive treatments used, patterns of organ dysfunction, and international differences, including gross national income.

The authors conclude: "There is considerable worldwide variability in decisions to withhold/withdraw life-sustaining treatments. Interestingly, almost one-third of patients with a decision to withhold/withdraw life-sustaining treatment left the hospital alive."

Among the more specific findings:  "The percentage of ICU non-survivors from North American ICUs in whom a decision was made during the ICU stay to limit life-sustaining treatment was 76%. In 1998, a study in 110 US institutions reported that 10% of 5,910 patients who died in the ICU had life-support withheld and 38% had life-support withdrawn.14 This observation suggests that the proportion of ICU patients who die after a decision to limit life-sustaining therapy may have increased in North America in recent years."