Prolonged ventilator dependence: economic and ethical considerations.

Patients who receive ventilator treatment tend to be older and sicker than ever before, factors that contribute to the complexity of ventilator weaning. The provision of prolonged ventilator support entails a commitment of expensive hospital resources, yet survival is often poor. Consideration must be given to limiting ventilator treatment in instances when benefit is highly unlikely or when the burdens of treatment outweigh benefits. Decisions to withhold or withdraw mechanical ventilation must be made with full knowledge and understanding of relevant ethical principles. If ventilator support is to be terminated, this should be accomplished according to institutional protocols that take into account these ethical considerations, as well as the medical and legal facts that apply.