Withholding and withdrawing medical treatment: An emergency medicine perspective

In emergency medicine, a significant difference rightfully persists between the withholding and withdrawal of life-sustaining medical treatment. The justification for this difference stems in part from the nature of emergency medical practice and the unique manner in which clinicians apply many ethical principles. In the usual setting, the decision to withhold further medical treatment is done quietly, often without input from the patient or surrogate decisionmaker, whereas withdrawal of ongoing medical treatment can be more obvious and difficult. This situation is reversed in the emergency medicine setting. The withholding of emergency medical treatment is much more problematic than later withdrawal of unwanted or useless interventions. Emergency physicians and prehospital providers often lack vital information about their patients' identities, medical conditions, and wishes. Society also has specific expectations of emergency physicians. Because of the nature of emergency medicine, both in the prehospital and the emergency department settings, the distinction between withdrawal and withholding of medical treatment has never disappeared and is not likely to do so in the future.