The Ethical Dilemma of Life Support: Deciding to Withdraw or Continue Treatment

There lies a man with no motor or sensory function, who can no longer breathe, eat, drink, or move on his own. He lies there as his life is slowly draining away and you know as a medical professional that the only thing keeping him alive are the “machines” such as: the ventilator, feeding tubes, intravenous fluids, defibrillation equipment etc. You stand there deciphering the end results if he were to be taken off the machine and a conflict comes to mind.

Your thoughts begin to race around in your head about whether it is wrong or right to let him lie there constantly being pumped to stay alive or whether you should take away the support and let him go to rest. There is no one simple answer to the conflict of whether it is right or wrong because the decision does not lie in your hands. As a state law, if the patient is not coherent to decide whether they want to withdrawal or stay on life support it goes to their designated person, and if one was not appointed it automatically goes to next of kin (Murrow).

As a medical professional your requirements are to adhere to the patients wishes and if they are not available then the wishes of the family are to be met, even if the family chooses against artificial nutrition and hydration. The family may ask to be educated on exactly what the artificial nutrition and hydration does for the individual. One author writes, in a clinical judgment paper that, “…Most patients and families do not have the medical knowledge and clinical experience to make medical decisions by themselves and therefore need the physician’s guidance.

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In which case, explanation on why ANH should be given and the benefits of it may be expressed but with minimal, if not none, of your personal persuasion. There is controversy over this entire debate of whether providing artificial nutrition is beneficial or not that it has actually prompted the American Academy of Hospice and Palliative Medicine to recommend that research be done and assessed in clinics so that clinical judgment and skill can be used to determine when it is appropriate (Slomka).

In one study, a man named, Bozetti and his colleagues decided to examine patient’s quality of life who had advanced cancer and who was on home parenteral nutrition (Fuhrman). In their study they noted that these patients were severely malnourished, could barely swallow, if at all, and were no longer receiving the curative therapy (Fuhrman). Their findings were reported back that the quality of life overall was much better for the patients who received HPN for a minimum of 3 months into their final stages of life (Fuhrman).

This study is one of many more that show that using nutrition and hydration in the end stages of life can be beneficial in fulfilling the patient’s needs to sustain life. There has been studies shown were artificial nutrition and hydration is beneficial in a case such as: “…A person who has a temporary bout of severe nausea and vomiting or has diarrhea causing serious dehydration can often benefit from a short course of intravenous fluids to rest the bowel” (Arenella).

Since this topic is so controversial the opposing side states that there are more, if not just as many, reasons why a person should not be held on life support. Many reasons include: “…Tubes can damage and erode the lining of the nasal passage, esophagus, stomach, or intestine” other complaints of infections, irritations, edema and many more medical problems are stated as bad outcomes of artificial nutrition and hydration (WebMD). Although these issues can arise it is still important to note that if the wish of the patient is to stay alive, ANH is what is actually allowing them to sustain their life.

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