Withdrawal of mechanical ventilation: ethical principles and guidelines for terminal weaning

BACKGROUND: Discontinuation of mechanical ventilation because of the recognition of futility of continued treatment or because of patient or family request is an increasingly frequent occurrence in critical care. Although there is broad consensus about the patient's right to refuse life support, little has been written about the actual procedure of withdrawing mechanical ventilation. OBJECTIVE: The purposes of this article are: (1) to review ethical arguments supporting the view that it may be morally permissible to withdraw mechanical ventilation from patients who are neither terminally ill nor imminently dying and (2) to provide guidelines for the procedure of ventilator withdrawal. METHOD: Ethical principles supporting the position that ventilator withdrawal under these conditions can be morally justified and principles suggesting that ventilator withdrawal is morally objectionable are evaluated. Factors contributing to clinicians' ambivalence about this issue and guidelines for planning and implementing treatment withdrawal are discussed.