Withdrawing life-sustaining treatment from severely brain-damaged persons.

Ventilator support is commonly withdrawn from unconscious patients who cannot breathe when it is reasonably certain that their condition is permanent and further medical treatment is futile. However, there is no consistent practice with permanently unconscious patients who can breathe but cannot swallow, despite the fact that ongoing treatment of these patients is similarly futile. In both groups of patients, the withdrawal of treatment is not euthanasia, and the cause of death is properly considered to be the underlying illness. A review of the medical, legal and ethical literature shows that there is much disagreement about when and how to withdraw tube feeding from patients with severe brain damage. Criteria for withdrawal of treatment should include the permanent unconsciousness of the patient, the permanent absence of a life-sustaining function, the elapse of sufficient time to be certain about the prognosis, the concurrence of at least one independent and qualified medical specialist, and the informed consent of the patient's family or other legally qualified agents.