The difference between withholding and withdrawing life-sustaining treatment.

OBJECTIVES: First, to present the position on the distinction between withholding and withdrawing life-sustaining treatment as expressed in guidelines and examine its relation to the attitudes of health care professionals. Second, to examine the possible ethical justification of this distinction. DESIGN, SETTING, AND PARTICIPANTS: Critical analysis of guidelines on life-sustaining treatment and questionnaire administered to 148 health care professionals--physicians and nurses at the intensive care unit (ICU), University Hospital MAS, Malmö, Sweden.
RESULTS: In contrast to the guidelines, which emphasize that there is no ethical difference between withholding and withdrawing life-sustaining treatment, not less than 50 per cent of the professionals in the ICU were of the opinion that there is an ethical difference. All attempts to justify this difference with reference to an inherent distinction between withholding and withdrawing seem to be controversial.
CONCLUSIONS: We recommend a change in emphasis in professional guidelines. Such guidelines should avoid the controversial issue about the possible inherent ethical difference between withholding and withdrawing life-sustaining treatment. What should be underlined is that the particular situation and the consequences of withholding as well as withdrawing life-sustaining treatment should always be taken into account.