The withdrawal of treatment — Withdrawal of Life-Sustaining Treatment, WLST for short — is the planned discontinuation of life-sustaining measures (ventilation, circulatory support, vasopressors) in patients whose prognosis no longer justifies the continuation of these measures. It typically takes place in the intensive care unit or in the operating room and clinically marks the transition into the dying phase (cf. phases of dying).
Ethical independence from the DCD question
The ethical assessment of the withdrawal of treatment belongs to the domain of determining the goal of therapy — the question of whether a medical measure still serves the appropriate goal of treating this human being in this situation. This question must be separated from the question, to be conducted separately, of donation after circulatory death (DCD):
- A withdrawal of treatment can be justified without a DCD following.
- A DCD can be considered only after an already-justified withdrawal of treatment — never the other way around.
Conflating the two questions would violate the Personalist Norm: the person may never become a means to the end of obtaining organs. The clean separation is a constitutive protective condition of donation after circulatory death.
Substance-ontological classification
The withdrawal of treatment is an expression of the insight that not every technically available measure serves a bodily person. It stands in the tradition of the Catholic magisterium (Pius XII, John Paul II, Evangelium vitae): the duty to preserve life binds one to proportionate measures, not to extraordinary technical prolongation of dying. Where a measure only prolongs dying without serving the person, its withdrawal is morally legitimate.
To be distinguished from this is active killing: the withdrawal of treatment allows dying to occur, while active killing sets the cause of death.
Clinical context
In the framework of controlled DCD (Maastricht III), WLST is an organizational precondition: circulatory arrest is expected after the planned withdrawal of treatment, not induced. After observed asystole, the five-minute observation follows, which is meant to secure permanence before organ removal begins.
The separation of the WLST decision and the DCD consideration is clinically safeguarded by organizational measures: separate teams, separate conversations with relatives, separate documentation.
Ontological classification
Superordinate concept: State of Affairs
Ontological relations:
- precondition of: controlled donation after circulatory death (Maastricht III)
- typically occurs in: the terminal phase in the intensive care unit
- to be distinguished from: active killing
- bound to: the determination of the goal of therapy, the Personalist Norm
Chapter assignment: Chapter 4: What is human personhood? (German), Chapter 5: Oblivion of the Person (German)
Sources
Generated by querying the Personhood ontology.
Further sources:
- Pius XII (1957): Address on the Prolongation of Life (to anesthesiologists, 24 November 1957). — Fundamental distinction between ordinary and extraordinary measures.
- Congregation for the Doctrine of the Faith (1980): Declaration Iura et bona on Euthanasia.
- John Paul II (1995): Evangelium vitae, no. 65 — on proportionate therapy.
- Bernat, James L. (2005): The concept and practice of brain death. Progress in Brain Research 150: 369—379. — On the clinical separation of WLST and DCD decisions.