[Abstention: arguments for stopping or withholding of life-sustaining treatment. Task Force Ethics, Philosophy and History of Medicine, Catholic University].

A decision to withhold or withdraw life-sustaining treatment can only be justified if one (or more) of three arguments apply: (a) the patient refuses the treatment concerned, (b) the therapy cannot produce the intended medical effect, or (c) the therapy may be effective, but the effects are not meaningful. Assessment of effectiveness is a medical professional judgement. This assessment should take into account the proportionality of medical (technological) means and ends. Treatment is meaningful if (a) it serves a reasonable purpose for the patient, and (b) the benefits outweigh the burdens for the patient. The patient's own view determines the meaningfulness of treatment. Physicians should talk with patients about the meaningfulness of life-sustaining treatment while there is time, to avoid the situation that such questions come up just when a patient has lost his capacity to communicate. In case a patient is incompetent, physicians should try to infer from previous utterances of the patient what he or she would have wished in this situation. If it is impossible to reconstruct the patient's view, there is no basis for withdrawing or withholding medically effective life-sustaining treatment.