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To the Editor.
—The article by Micetich et al discussed two hypothetical cases of comatose, respirator-dependent patients who are irreversibly and terminally ill. The authors conclude that IV fluids may not always be morally required for such patients. However, the authors also decide that mechanical ventilation must be continued. The authors state that, although withdrawing respiratory support is "morally possible," it "creates an immediate consequence of death" and represents "an extreme form of abandonment."Can IV fluid administration become an "extraordinary" (nonobligatory) means while a respirator remains an "ordinary" (obligatory) means? In other words, isn't the suffering caused by inappropriately continuing respiratory support in dying patients just as great as that caused by inappropriately prolonging the death process with other life-sustaining measures?I suspect that many of us who care for terminally ill patients have also found ourselves illogically but helplessly hooked on respirators. We must learn more about weaning
Donnelly WJ. Intravenous Support in Dying Patients. Arch Intern Med. 1984;144(2):420. doi:10.1001/archinte.1984.00350140254051