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Withdrawing Very Low–Burden Interventions in Chronically Ill Patients
Jill A. Rhymes, MD;
Laurence B. McCullough, PhD;
Robert J. Luchi, MD;
Thomas A. Teasdale, DrPH;
Nancy Wilson, MA
JAMA. 2000;283:1061-1063.
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Discussions of withdrawing or withholding treatment from patients have focused, for the most part, on critical care management of gravely ill patients or those with advanced or end-stage disease. In this article, we address the distinctive ethical issues that arise when the physician considers withdrawing low-burden clinical management from chronically—but not critically—ill patients.
Case Report
Reverend G is an 85-year-old white man with severe dementia. Except for dementia, he is in fairly good physical health. He had a pacemaker implanted several years previously. He has marked behavioral problems, including combativeness and physical aggression, and no longer recognizes his family members. He now resides in a nursing home in a locked dementia unit. Multiple trials of neuroleptics (typical and atypical), trazodone, and sedatives have failed to control his hallucinations and aggressive behavior and/or caused . . . [Full Text of this Article]
Author Affiliations: Huffington Center on Aging (Drs Rhymes, McCullough, Luchi, Teasdale, and Ms Wilson) and Center for Medical Ethics and Health Policy (Dr McCullough), Baylor College of Medicine, Houston, Tex.
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