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Quick Tip for Families in Intensive Care: Is It Ethical & Legal for ICU Teams to Withhold Treatment to Hasten Death Against Patient & Family Wishes?

Based on ICU standards, is it ethical or acceptable for doctors to withhold treatment and care, i.e. antibiotics, pressors, to hasten death against the patients and family’s wishes?

That’s a question that I have from one of our clients that I am going to answer today.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

Today’s tip and question comes from one of our clients as part of a medical record review that we have done for the client who had their mother in intensive care. The question that she has specifically is based on ICU standards, is it ethical or acceptable for doctors to withhold treatment and care, i.e. antibiotics, vasopressors to hasten death against the patients and family’s wishes?

We have answered that question. I will go through it in a minute. But I think the question should have also been phrased as based on ICU standards, is it ethical, acceptable, or legal to withhold care and treatment, i.e. antibiotics, vasopressors to hasten death against the patient and family’s wishes.

Now one thing that I really want to set the scene with here is end of life care decisions in intensive care do not happen in a vacuum. It is not the case on whether they are ethical or acceptable. It is a case of whether they are legal. Letting someone die or potentially withdraw life support is a legal question, not an ethical question. I am all for ethics and whilst I think it is not ethical to answer the question quickly before I go into much detail. Why? The question really is it legal? It is probably not, but we will come to that.

Because what I can tell you is after having done this work for so long, there is really not one jurisdiction where doctors and nurses or ICU teams can just remove life support without consent. That could be perceived as euthanasia. It could be perceived as murder. There are all sorts of legal implications. It does not happen in a vacuum.

Anyway, according to ICU standards, withholding care or treatment to hasten death against the patients or families is neither ethical, legal, nor acceptable, and here is a breakdown of why.

Medical ethics, legal ethics, and patients’ rights, autonomy, patients or their surrogates, if incapacitated, have the right to make decisions about their care and treatment. This includes the right to request life sustaining treatment, such as antibiotics or vasopressors. It also includes the right to stop treatment if that is what a patient or a family wants.

Next, beneficence and nonmaleficence. Physicians and doctors are ethically obligated to act in the patient’s best interests and avoid causing harm. Withholding treatment to deliberately hasten death, especially against the wishes of the patient or family, violates these principles.

Legal standards. In the US, UK, and Australia, withholding or withdrawing life-sustaining treatment without consent can be considered medical neglect or even homicide, depending on the intended outcome. Surrogates have legal authority to make healthcare decisions when patients cannot, and their decisions must be honored unless a court or ethics committee intervenes.

Next, ICU and hospital policies. Most ICU guidelines emphasize shared decision making. Treatment can be limited or withdrawn only when there is consensus that it is non beneficial or burdensome, and with family, patient, or surrogate involvement. if there is disagreement, hospitals usually involve an ethics committee, palliative care, or a second opinion rather than unilaterally ending treatment.

This is what we are here for, to give you a second opinion, to give you a perspective.
Hospitals and ICUs, in particular, are very good at pretending they can do whatever they want, which was the case in, in our client’s situation. They just pretended they can just stop treatment without asking anyone. Imagine that.

End of life care does not happen in a vacuum. Hospitals pretend that they operate in a vacuum, but they do not. What to do if you suspect this is happening, if you’re worried that care and treatment is being withheld to hasten death? Request detailed documentation of the care plan, get access to the medical records, consider transferring to another hospital or a second opinion, which we can give you here at intensivecarehotline.com, and consult patient and family advocates or legal representative. Once again, that is us here at intensivecarehotline.com.

What hospitals often do is they try to bring in ethics committees to make it look, “ethical” to end someone’s life, but those ethics committees are flawed, and here is why.

The ethics committee are never independent. They’re never not hospital employees, which means they’re biased, and they will do whatever is in the hospital’s best interest, not what’s in the patient’s best interest. I’ve seen it over and over and over again. That ethics committee are biased, they’re hospital employees, and therefore, they are not independent. It’s as simple as that.

I would stay clear of ethics committees unless you have reassurance that ethics committees are independent and are not part of the hospital and their employees. Because ICU care based on clinical guidelines ensures effective and safe interventions to critically ill patients. It always involves a multidisciplinary team, doctors, nurses, specialists, working collaboratively and communicating effectively to ensure optimal patient outcomes, according to a patient or their family’s wishes.

The ICU team must respect patient autonomy and the right to refuse having treatment stopped. And if the ICU clinicians do not involve patients and families in decision making, explaining treatment options, risks and benefits, and respecting the values and preferences, they’re not acting within ICU standards. A decision to withdraw life sustaining treatment and care is only ethically and legally permissible if it aligns with the patient’s goals of care and treatment, even if it may result in end of life.

This also includes is that ICU teams or medical teams should be prepared to address emotional and psychological needs of the patient’s family, especially during difficult times, and that’s certainly not happened in this situation. It doesn’t happen in many situations because if ICUs go in with a “hammer” and say, “Well, tomorrow at 3 o’clock, we’re going to stop life support for your loved one, whether you like it or you don’t,” that is not taking emotional and psychological needs of the patient and the family into consideration. I hope that answers your question.

I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in intensive care nursing, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.

I can very confidently say that we have saved many lives for our clients in intensive care. And you can verify that on testimonial section at intensivecarehotline.com.  You can verify it on our intensivecarehotline.com podcast section. And you can read what our clients say, and you can verify it in a podcast where we have done client interviews how we have saved many lives in similar situations where we just intervened successfully, knowing patients’ and families’ rights in intensive care and pointing out that ICU teams do not operate in a vacuum.

Our advice is absolutely lifechanging. Once again, it is absolutely life changing which is why we have so many testimonials and interviews from clients.

You can join a growing number of clients and members that we have helped over the years. And you can become one of the success stories that we are publishing here at intensivecarehotline.com because we have helped so many families in intensive care over the years, improve their lives instantly, making sure that our clients make informed decisions, have peace of mind, control, power, influence. We’re bringing in transparency that ICU teams often try to withhold by not giving access to medical records, even though that’s your right.

We help our clients to get access to medical records, making sure it’s all transparent, and guide them from there with the right questions, with the right advocacy so that our clients can make informed decisions, have peace of mind, control, power, and influence making sure their loved ones get best care and treatment, always.

That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, WhatsApp whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong.

I also talk to doctors and nurses directly, and when I talk to doctors and nurses directly with you or on your behalf, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.
We also do medical record reviews in real time so that you can have this second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com if you click on the membership link, or if you go to intensivecaresupport.org. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I’ve personally written and recorded that are exclusively available to our members. And all of that will help you to make informed decisions, have peace of mind, control, power, and influence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, comment below what you want to see next, what questions and insights here from this video, share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on a show, and you will get notification for the YouTube Live if you’re a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.