WITHHOLDING AND WITHDRAWING MEDICAL-TREATMENT - AN EMERGENCY-MEDICINEPERSPECTIVE

In emergency medicine, a significant difference rightfully persists be tween the withholding and withdrawal of life-sustaining medical treatm ent. The justification for this difference stems in part from the natu re of emergency medical practice and the unique manner in which clinic ians apply many ethical principles. In the usual setting, the decision to withhold further medical treatment is done quietly, often without input from the patient or surrogate decisionmaker, whereas withdrawal of ongoing medical treatment can be more obvious and difficult. This s ituation is reversed in the emergency medicine setting. The withholdin g of emergency medical treatment is much more problematic than later w ithdrawal of unwanted or useless interventions. Emergency physicians a nd prehospital providers often lack vital information about their pati ents' identities, medical conditions, and wishes. Society also has spe cific expectations of emergency physicians. Because of the nature of e mergency medicine, both in the prehospital and the emergency departmen t settings, the distinction between withdrawal and withholding of medi cal treatment has never disappeared and is not likely to do so in the future.