Hospital Policy Variation in Decisions to Withhold or Withdraw Life-Sustaining Treatment

Abstract: Decisions to withhold or withdraw life-sustaining treatment (LST) for critically ill patients can be ethically controversial, especially when disagreements over these decisions exist among clinicians, patients, and surrogates. Sociodemographic disparities make this issue particularly fraught, especially in light of recent evidence that clinicians disproportionately make unilateral decisions to withhold LST for patients in certain vulnerable populations. For example, clinicians more often use unilateral do-not-resuscitate orders for Spanish-speaking patients and more often withhold extracorporeal life support for patients who are female, insured by Medicaid, or live in low-income neighborhoods.
This panel – composed of experts in palliative medicine, critical care, clinical ethics, and law – will describe and explicate how United States hospital policies currently address decisions to withhold or withdraw LST in ethically controversial scenarios and explore how these policies ought to address these scenarios. First, we will explore the findings of a national study of American Society of Bioethics and Humanities members assessing the content of hospital policies from all 50 US states, Puerto Rico, and Washington DC. This work has demonstrated that hospital policies vary in (1) their approaches to ethically controversial scenarios amidst clinician, patient, and surrogate conflict and (2) how (if at all) they address sociodemographic disparities related to withholding or withdrawing LST. Subsequently, we will discuss important ethical and legal implications arising from the results of this study. Last, we will explore how hospital policies may be updated to better address sociodemographic disparities in clinician decisions to withhold or withdraw LST.