Ethical Challenges and Stress for Health Care Professionals in Life Support Withdrawal.

Abstract

Withdrawing life-sustaining treatment (WLST) in terminally ill patients' presents significant ethical and emotional challenges for health care professionals. This cross-sectional study surveyed 436 health care providers at a teaching hospital in central Taiwan to explore the conflicts and stressors they face during WLST. Key ethical conflicts included unclear definitions of terminal illness, differing family attitudes, and ambiguous responsibility for extubation. Major stressors involved performing extubation, disclosing medical conditions, providing grief support, and navigating institutional procedures. Unmarried, younger, less experienced staff, particularly those without children or working in pediatric or surgical ICUs, were more susceptible to ethical stress ( P <.01). Nurses and respiratory therapists reported more conflict over extubation responsibility, while physicians struggled more with defining terminal illness ( P <.05). The findings highlight the need for clear guidelines, structured family meetings, multidisciplinary coordination, targeted education, emotional support systems, and broader public engagement with advance medical directives to reduce the ethical burden on health care professionals involved in WLST.