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March 1, 1995

Withdrawing Life SupportHow Is the Decision Made?

Author Affiliations

From the Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, and the Stanford University Center for Biomedical Ethics, Stanford, Calif.

JAMA. 1995;273(9):738-739. doi:10.1001/jama.1995.03520330068040

Withholding and withdrawal of life support in intensive care units (ICUs) has become the norm rather than the exception in the United States since the mid 1980s.1,2 We are all familiar with the tremendous impact of the Karen Ann Quinlan case in 1976, the report of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1983, and the subsequent flurry of position statements from a multitude of individuals and professional organizations (for example, the American Thoracic Society) underscoring the fundamental right of patients or legal surrogates to refuse unwanted medical therapies.3-5 Several clinical studies during the past few years have revealed that 40% to 65% of ICU deaths have been preceded by decisions to withhold or withdraw life support. In some cases, the percentage is even higher.6,7 Health care professionals are responsible for informing patients, families, and surrogates about

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