ICU treatment strategy in case of the decision to withhold or withdraw life-supporting treatment
In order to offer patients with life-threatening conditions good and safe care, planning of the care is required to facilitate work so that care can be directed towards the goals of treatment.
Physicians with ties to the intensive care unit are responsible for intensive care during their duties, conducted in close consultation with the responsible physician from the central hospital (permanent care contact).
The most common treatment strategy is “full effort”, that is, no restrictions on medical treatment measures. But in connection with the admission to the intensive care unit due to a life-threatening condition or worsening of the condition during treatment, it may be necessary to limit the treatment - either to withhold (to not begin) or to withdraw (to discontinue) ongoing life-supporting treatment.
The grounds for such a decision (position) can be the patient's own volition (autonomy), acute or chronic disease prognosis as well as treatment failure despite ongoing treatment.
The treatment may lack the ability to provide medical effect and cause discomfort, pain and complications. In that case, it causes suffering instead of healing and help.
The choice of a treatment strategy is based on ethical principles as well as medical science and proven experience. Health legislation emphasizes respect for the patient's autonomy and integrity, and it states that care be designed and carried out in consultation with the patient in as far as possible. A physician may not provide a treatment that the patient does not want, with the exception of, for example, care under the Psychiatric Care Act.
Respecting the patient's wish to no longer receive life-supporting treatment is an obligation under Swedish constitutional law. This also applies if a patient has rejected any other treatment that could have saved his or her life.
When there is a medical and ethical consensus and it has been decided to withdraw life-supporting treatment, the patient is transferred to palliative care. Dying is an unpredictable natural process and must be given the necessary time. This process should not be hindered by intensive care action when the patient has reached the final stages of life.
In palliative care, the patient's need for comfort, pain relief, anxiety reduction and security is met. A single room and privacy are important. The physician's commitment and presence are required for the decision to withhold or to withdraw life-supporting treatment. Relatives should be prepared for what is going to happen, and be given the time and space to be with the patient and get to understand the situation. The staff’s mission is to support the needs of patients and close relatives in the best possible way, including spiritual, cultural and psychosocial support.