Neither the day nor the hour: withdrawal of life-prolonging measures from patients who wish not to know that they are going to die
Thursday, October 12, 2023
4:00 PM – 5:15 PM ET
Location: Heron (Fourth Floor)
When US critical care physicians conclude that an adult patient will never wean off invasive mechanical ventilation, there is a pervasive expectation — often enshrined in states’ healthcare decision making statutes — that the capacitated patient or their authorized representative will decide whether to continue with invasive life-sustaining interventions. When life-sustaining interventions are to be discontinued, the patient’s surrogate or, less commonly, the patient themself will decide that the invasive life-sustaining intervention should stop and at roughly what time, essentially deciding the day, if not the hour, that the patient will die.
But what of capacitated adult patients who do not wish to know the day, still less the hour, of their death? This paper considers the case of an adult, capacitated patient who is newly ventilator dependent who requests that an authorized surrogate decide whether the patient continue with mechanical ventilation and, if the surrogate decides against ongoing ventilation, that the decision be implemented without the patient becoming aware of it. This paper first rehearses ethical views developed in response to adjacent cases: discontinuation of extracorporeal membrane oxygenation, withholding information from capacitated patients upon their request, withholding information in pediatrics, and religious prohibitions on active withdrawal of life support. The paper then argues that while it is difficult to sustain a principled argument against permitting capacitated patients to defer both end-of-life decisions and awareness of them to surrogates, other ethical considerations may weigh against the practice.