Variation in US Hospital Policies Addressing Decisions to Withhold and Withdraw Life Sustaining Treatment

Outcomes 1. Attendees will understand the extent US hospital policies address sociodemographic disparities in decisions to withhold or withdraw life sustaining treatment.2. Attendees with learn about reasons hospital policies permit the withholding or withdrawing life sustaining treatment. Key Message Hospital policies on withholding or withdrawing LST vary widely across the United States and rarely address sociodemographic disparities in decision-making. Future research is needed to address reasons for these findings and identify mechanisms to reduce sociodemographic disparities in decisions to withhold or withdraw LST. Introduction/Context Sociodemographic disparities in clinician decisions to withhold or withdraw life sustaining treatment (LST) are known to exist (1,2). Objectives How do United States hospital policies recommend approaching decisions to withhold or withdraw LST? Methods This national cross-sectional survey assessed the content of hospital policies addressing decisions to withhold or withdraw LST. We distributed the survey electronically to American Society of Bioethics and Humanities members between July and August 2023 and descriptively analyzed responses. Results Among 93 respondents from hospitals or hospital systems from all 50 US States, Puerto Rico, and Washington, DC, 92% had policies addressing decisions to withhold or withdraw LST. Hospitals varied in their stated guidance, permitting LST to be withheld or withdrawn in cases of patient or surrogate request (82%), physiologic futility (81%), and “potentially inappropriate” treatment (64%). Of the 8% of hospitals with policies that addressed patient sociodemographic disparities in decisions to withhold or withdraw LST, these policies provided opposing recommendations to either exclude sociodemographic factors in decision-making or actively acknowledge and incorporate these factors in decision-making. Nearly half of hospitals (47%) explicitly included clinician value judgments within their policies, such as describing that withholding or withdrawing LST could be supported if the patient had no chance of returning to a “meaningful” life. Only 3% of hospitals had policies that recommended collecting and maintaining information about patients for whom LST was withheld or withdrawn that can be used to identify disparities in decision-making. Conclusion Hospital policies on withholding or withdrawing LST vary widely across the United States and rarely address sociodemographic disparities in decision-making. Future research should address reasons for these findings and identify mechanisms to reduce sociodemographic disparities in decisions to withhold or withdraw LST. Keywords Ethical / Legal Aspects of Care; Diversity, Equity, Inclusion, Belonging, Justice