Withholding and withdrawing treatment: practical applications of ethical principles in end-of-life care

Abstract

The paper discusses the statement that withholding or withdrawing treatment can be considered a sound clinical decision when reached in discussion with the patient (if competent), the family and the clinical care team. In the practical setting of end of life care, the four principles of ethics as described by Beauchamp and Childress provide a pratical framework for consdiering ethical decision making. The four principles are described with regard to end of life and pallaitive care. The article refers to SA Law Commission recommendations; to UCT Bioethics Centre statement on withholding and withdrawing treatment; and the imortance of palliative care training for clinicians caring for patients at the end of life. Refusal of treatment, futile treatment and Advance Directives are considered as practical settings that influence decision making. The synergy of bioethics and palliaitve care to maintain or reinstitute humane medicine is discussed.