Withholding and Withdrawal of Life-Sustaining Treatment in Palliative Care: Ethical, Legal, and Cultural Perspectives in Indonesia

Abstract

Withholding and withdrawal in palliative care is a dilemma frequently faced by medical personnel, patients, and their families. For palliative care patients, therapy and interventions deemed ineffective should be avoided. This is done by considering the patient's wishes and comfort, especially as they approach the end of life. Competent patients can decide about the treatment and intervention options to receive. However, many palliative care patients are incompetent, requiring others to take over decision-making. Ethical, legal, cultural, religious, and social issues always accompany medical decision-making. Every person involved, whether clinicians, nurses, families, or society itself, has their own views about medical care, especially when the decision to withhold or withdraw life-sustaining therapy is inevitable. Discussions about death with living individuals are considered taboo in some cultures, including Indonesia. Therefore, planning for advanced medical therapy and all discussions related to end-of-life patient care, such as Advanced Care Planning, present a unique challenge for palliative care clinicians. We reviewed some papers related to this topic because it is still becoming ‘a grey area’ for clinicians. This review focused on the multifactorial challenges that should be addressed by clinicians before deciding to withhold or withdraw care in palliative care patients, especially in Indonesia.