Withholding and withdrawal of life-sustaining treatment in a Lebanese intensive care unit: a prospective observational study

Objective: To evaluate the implementation and process of withholding and withdrawing life-sustaining treatment in an intensive care unit. Design and setting: Prospective observational study in the medical intensive care unit of a university hospital in Lebanon. Patients: Forty-five consecutive adult patients admitted to the ICU for a 1-year period and for whom a decision to withholding and withdrawal of life-sustaining treatment was made. Measurements and results: Patients were followed up until their death. Data regarding all aspects of the implementation and the process of withholding and withdrawal of life-sustaining treatment were recorded by a senior staff nurse. Withholding and withdrawing life-sustaining treatment was applied to 9.6% of all admitted patients to ICU. Therapies were withheld in 38% and were withdrawn in 7% of patients who died. Futility of care and poor quality of life were the two most important factors supporting these decisions. The nursing staff was not involved in 26% of the decisions to limit care. Families were not implicated in 21% of the cases. Decisions were not notified in the patients' medical record in 23% of the cases. Sixty-three percent of patients did not have a sedative or an analgesic to treat discomfort during end-of-life care. Conclusions: Life-sustaining treatment were frequently withheld or withdrawn from adult patients in the Lebanese ICU. Cultural differences and the lack of guidelines and official statements could explain the ethical limitations of the decision-making process recorded in this study.