Withdrawing and withholding life support in the prehospital setting

Abstract

The 2005 French End of Life law gives the right for patients to refuse any therapeutic obstinacy and the obligation for each physician not to expose any patient to such obstinacy. When deciding to withhold or withdraw life support, the law clearly recommends the implementation of an ethical approach that respects patient’s autonomy. However, the process of life support discontinuation or limitation as defined by the law remains poorly applicable in the setting of out-of-hospital emergency.

Despite such limitations, unnecessary and disproportionate treatments should not be implemented in the emergency setting. Collegiality and decision sharing between care providers should be a priority, avoiding any single individual decision, especially when the patient is not able to decide for himself. The required steps leading to the final decision should be clearly identified and written.

Decision to withhold or withdraw life support means that cares should be continued including palliative cares. Collaboration between the pre-hospital and palliative care teams facilitates patient management and dispatching by the emergency medical services. This approach is possible if emergency physicians are trained to such situations and familiar with ethical issues and palliative medicine, in order to treat patients as fair and reasonable as possible.