Reasons for withdrawing treatment in patients receiving intensive care

We studied the frequency with which treatment was withdrawn in intensive care patients and the primary reason for reaching this decision. The medical records of patients having had active treatment withdrawn between August 1992 and February 1996 inclusive were reviewed. Patients were classified into an imminent death group consisting of those expected to die, a qualitative group who had treatment withdrawn on quality of life considerations and a lethal conditions group who had associated disease that precluded long-term survival. There were 1745 patients admitted, of whom 338 (19.4%) died in ICU. In 220 patients death followed the withdrawal of treatment (12.6% of all ICU admissions), 203 dying on ICU (60% of ICU deaths) and a further 17 soon after discharge to a ward. The primary reason for treatment withdrawal was imminent death in 45% of patients, qualitative considerations in 50% and lethal conditions in 5%. The reason varied significantly depending on the patient's age. Treatment is withdrawn commonly in ICU, the primary reason being quality of life considerations as often as because death is the expected outcome.