Joumal of Advanced Nurstng, 1992,17,1440-1446 Assessing quality of life: the basis for withdrawal of life-supporting treatment? Paul Fulbrook BSc(Hons) RGN DPSN Course Teacher, Intensive and Coronary Care Nursing, Department of Advanced Nursing Studies, School of Health Studies, University of Portsmouth, Hampshire P06 3LY, England Accepted for pubiicahon 6 Apnl 1992 FULBROOK P (1992) Journal of Advanced Nurstng 17,1440-1446 Assessing quality of life: the basis for withdrawal of life-supporting treatment? In this paper, the ethical issue is addressed of withdrawing life support by asbng the queshon, 'What is quality of life?' It focuses on the assessment of quality of life, examining how such assessments are made, and highlighting the inability of cntically ill pahents to participate in decisions regardmg termination of their life WITHDRAWAL OF LIFE-SUPPORTING TREATMENT The medico-ethico-legal issue of withdrawing hfe- supporting treatment is a relatively new phenomenon when considered m histoncal terms, for it is really within the last 30 years only that the sophishcated medical technology which is necessary for 'hfe support' has been available Indeed, intensive therapy uruts (ITUs) 30 years ago were only a shadow of today's modem technodromes, concentrahng mainly on medical support relatmg to diseases affechng only one vital organ One of France's early mtensivists, the late Maunce Rapin, recalls his early expenences m intensive care, saying At that time, as far as I am aware, there was no question of etbcal restraint We accepted virtually all the patients referred to us and, for all of them, we did everything in our power to help (Rapin 1987) He suggests that medicine was much simpler then because treatment was usually undertaken for patients with only one organ failure Thus, if medical efforts were successful then the pahent would be able to resume a nonnal lifestyle There was nothing to lose and everythmg to gam' (Rapin 1987) Modem technology and expertise m relahon to life support has advanced considerably smce Rapin's early days Many patients are now survivmg illnesses ununagm- able 30 years ago Indeed, mtensive therapy facilitates the recovery of people from such thmgs as open-heart surgery, bram surgery and mulhple trauma whose prognosis then would have been virtually ml Multi-system support Advancmg technology has seen the development of mulh- system support for cnhcally ill pahents Thus, patients whose medical prognosis would previously have been regarded as hopeless are now able to benefit from aggressive medical intervention which is often life saving Inevitably, such treatment has lead to prolonged and protracted deaths for some unfortunate people, who, despite all efforts to save them, have died There is also a large group for whom survival of aggressive treatment may be regarded as incomplete when assessing quality of hfe The general ethos withm the health care professions must be m support of aggressive intensive therapy since it continues to be pursued with increasing vigour This may relate mainly to man's dominant philosophy regardmg sanctity of life resultmg m a reluctance to allow people to die 'normally' Indeed, if statishcs are quoted for intensive care survivors they are mvanably m terms of survival which says very httle about quality of life Aggressive therapy may even be justified by the medical profession on the basis that something good will have been leamt from 1440