Therapeutic obstinacy in critical care patients : ethical issues related to withholding and withdrawing of treatment

Abstract

The desire to save a patient’s life, even when seriously sick and without hope of recovery, might push treatment beyond acceptable limits, resulting in what is known as ‘therapeutic obstinacy’. This research focuses on the ethical dilemma as to when and if to administer treatment, and how and when to stop and let nature take its course. This phenomenon is a result of lengthened life expectancy due to the merging of technological advancements in the medical field. This research compares and analyses how different European countries deal with such an issue. The Maltese situation is also analysed, highlighting the lack of legislations and guidance regarding this subject. This research takes the form of a literature review whereby vast literature on the subject was studied and the information collected was used to answer the main research questions, being “When is it ethically correct to withdraw or withhold treatment for patients in critical care, when death is inevitable no matter what treatment is administered to them?” A variety of data sources were used, including journals, newspapers, legislations, guidelines and court cases among others. The study outlines how therapeutic obstinacy creates an ethical problem, whereby the original aim is well intentioned but the actions used to persevere life at all costs brings negative effects, such as the prolongation of pain, suffering and distress on the patient, relatives and healthcare workers. Withdrawing or withholding treatment when there is no chance of cure can therefore help in avoiding therapeutic obstinacy and prevent futile treatment, being treatment which fails to restore health as one would expect medical interventions to do. Taking such an action allows to accept the faith of the patient and let nature to take its course while possibly preparing the patient and family members to face the death process as serenely as possible. Throughout the study the importance of taking decisions in accordance to what is best for the patient is continuously highlighted. This study outlines the need for Malta to address the lack of knowledge and guidance with regards to therapeutic obstinacy, suggesting the introduction of legislations and guidelines which could adequately help in avoiding such situations in the local medical practice.