Withholding life-sustaining therapy in the emergency department: The perspective of emergency physicians in a conservative society

Abstract

Patients at end of life (EOL) commonly present to the emergency department (ED) for acute unpredicted life threatening emergencies. The aim of this study is to assess the perspective of the Lebanese emergency physician (EP) in withholding life-sustaining therapy (LST). We elaborated a questionnaire to evaluate the perspective of EP in withholding LST in patients at EOL. The questionnaire was then answered by 80 EP after its validation. The decision to withhold LST was most commonly made by the physician with limited involvement of the nursing staff and the patient. Patients in university hospital (UH) were more involved in the decision-making process of withholding LST (71.0% vs 36.8%; P = 0.005), but were less alerted of the final decision (77.5% vs 95.0%; P = 0.023). The patients’ families were more involved in the decision to withhold LST than the patients themselves (P < 0.001). The most common reasons to withholding LST included advanced cancer (81.3%) followed by the patients’ wishes (80%). It is noteworthy that EP of UH had significantly more reasons to withhold LST (P < 0.001). Our patients benefited from palliative care in 62.5% only which limited the percentage of patients discharged home to 46.3% (UH 52.5% vs NAH 40.0%; P = 0.263). The results of our study raise a number of ethical issues namely the paternalistic relationship between patients at EOL and EP, the poor participation of the medical staff and that of the patients and their families in the decision process to withhold LST.

Keywords:

• Emergency
• Life-sustaining treatment
• Treatment withholding
• End of life
• Palliative care
• Lebanon

ORCiD

Elie El Rassy http://orcid.org/0000-0002-7906-0991