Dr? Who? Can nurses act as withdrawers of life sustaining treatment?

Research output: Contribution to conferenceConference Abstractpeer-review


At times where active treatment of a critically ill patient no longer benefits that patient, it is ethically and legally allowed that treatment be withdrawn, even if this results in that patient’s death. When such a legally and ethically robust decision has been made to withdraw life sustaining treatment, but withdrawal is delayed because no doctor is available, should nurses step in and facilitate withdrawal by turning off ventilators, removing endotracheal tubes and stopping infusions?

An inconvenient truth?
When planned withdrawal is delayed, patients and their families can experience significant distress. For instance, families may travel considerable distances in order to congregate with their loved ones, protracted waiting for an inevitable withdrawal may be unbearably emotionally distressing, and patients may require invasive interventions such as physiotherapy or increases in ventilation, sedation or inotropes in order that clinicians remain in control of distressing symptoms. At busy times, delays to planned withdrawal may not just happen once, but on several occasions. In these circumstances, anecdotal reports indicate that nurses sometimes withdraw treatment from patients in lieu of doctors. Yet these activities exist in a closed world due to uncertainty over their legal status; indeed, while their legality is unexplored, it is also an open question within the nursing profession whether such activities constitute ‘real’ nursing at all, or are instead ‘doctor’s work’.

A clarification of law
Building on legal research recently published in the Medical Law Review, this presentation explains the legal and professional landscape in which such activities reside, before discussing preliminary evidence of nurses’ considerations of withdrawal within practice, and the ethical and practical dilemmas that are raised.

A plan for the future... and a challenge to the present
Arguing that current workforce trends inside and outside the PICU are likely to see nurses under increasing pressure to carry out unassisted withdrawals, I suggest that the issues this raises require PICU clinicians of all disciplines to have an open and honest debate over professional distinctions and task demarcation in order to plan for the future. I discuss arguments suggesting nurses may have adequate ethical justification to act as withdrawers, and consider some of their potential pitfalls. Finally these ethical justifications are combined with the legal and professional analysis in order to sketch practical guidelines for nurses acting as withdrawers of treatment.
Original languageEnglish
Publication statusPublished - 27 Sep 2012
EventPaediatric Intensive Care Society - International Convention Centre, Dublin, United Kingdom
Duration: 26 Aug 201528 Aug 2015


ConferencePaediatric Intensive Care Society
CountryUnited Kingdom

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