Medical Staff House Staff Orientation Manual - Montefiore Medical ...

Bioethics (Moses) 718-920-6226
(Weiler) 718-904-2299
Office of the Medical Director 718-920-7052; 2809; 6078
FOREGOING LIFE-SUSTAINING TREATMENT
Summary - Administrative Policy and Procedure # JA12.1
Note: This summary contains the key points of this policy. For a complete understanding of all
the relevant provisions, it is necessary to thoroughly read the full policy.
WHAT:
This policy delineates the roles of the physician and the members of the health care team in
guiding patients, their health care agents, family or other surrogates in end-of-life decision
making. In recommending and responding to decisions about foregoing (withholding or
withdrawing) life-sustaining treatment, physicians and other clinicians should be guided by the
following principles:
• Physicians and other clinicians have no medical, legal or ethical obligation to offer or
provide treatment(s) that are not medically indicated or to offer or provide treatment that
would increase a patient’s suffering or merely prolong the dying process.
• Any decision to forego life-sustaining or other medically indicated treatment(s) should
trigger a process of discussion about the reasons for the decision, the consequences of
foregoing treatment and the range of appropriate therapeutic options, including palliative
care. A Palliative Care Medicine or a Bioethics consult and/or a family meeting may be
helpful in clarifying the goals and plan of care.
• Physicians caring for a patient who is terminally ill should discuss a palliative care plan or a
time-limited course of supportive treatment (e.g., dialysis) with the capacitated patient or
surrogate. These discussions should include a review of the patient’s condition and
prognosis and the patient’s present (or prior) declared health choices.
WHO:
• The patient, family or anyone on the health care team may initiate a discussion about
foregoing treatment.
• The patient’s attending physician determines when foregoing treatment is medically
indicated and recommends this course to the capacitated patient, or the health care agent or
other surrogate who makes decisions for the incapacitated patient.
WHEN:
Foregoing life-sustaining treatment is appropriate whenever a patient’s condition and prognosis
are such that one or more interventions are likely to merely prolong dying or increase suffering
without providing substantial benefit.
WHERE:
Orders to forego life-sustaining treatment may be appropriate in any clinical setting.
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