• D Y Tai and T W Lew.
• Department of General Medicine, Tan Tock Seng Hospital, Singapore. dessmon_tai_yh@notes.ttsh.gov.sg
• Ann Acad Med Singap. 1998 May 1; 27 (3): 430-6.

AbstractAdvances in medical technology have rendered the ability to provide prolonged physiologic support of incurable or terminally ill patients commonplace in the intensive care unit. In tandem, there has been a global shift in the intensivist's mindset from solely pursuing an unrelenting course of aggressive therapy, to a recognition of the limitations of intensive care and the appropriate discontinuance of nonbeneficial therapy. Underpinning this shift remains the physician's adherence to the ethical principles of beneficence, nonmaleficence, and disclosure; the patient's right to autonomy and self determination; and the community's right to just distribution of medical resources. When the doctor assumes the role of patient advocate, and assesses illness severity and evaluate recovery, or lack of, to a quality consistent with the patient's own life philosophy, he is able to communicate to the family a course of action that is in the patient's best interest. A consensus on withholding or withdrawal of care is often then achieved. The process of foregoing or withdrawing life-sustaining therapy itself, must be carried out with sensitivity and empathy, with the primary goal of providing comfort and reducing suffering.

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