Penn critical-care physicians recommend strategies when facing requests to end supplemental oxygen

(Philadelphia, PA) - Critical care physicians with the University of Pennsylvania Health System address a newly-emerging ethical dilemma in medicine - what should health care professionals do when faced with a request from a patient to end the use of life-sustaining supplemental oxygen? Scott Halpern, MD, PhD, a fellow in the Division of Pulmonary, Allergy and Critical Care Medicine and senior fellow with the Center for Bioethics at Penn, along with John Hansen-Flaschen, MD, chief of the Division of Pulmonary, Allergy and Critical Care Medicine at Penn, have co-authored a guide for physicians faced with such requests. The commentary - which examines concerns physicians may have in removing such a minimally invasive and potentially palliative therapy, and suggests strategies for physicians to overcome them -- is in the September 20th issue of JAMA, the Journal of the American Medical Association.

Halpern explains, "Informed patients with decision-making capacity have well-established rights to forgo any and all forms of life-sustaining therapy. However, there is no clear definition of what constitutes a life-sustaining therapy. We tend to think of invasive medical therapies such as mechanical ventilation, kidney dialysis or tube feeding. When administered by face mask or nasal prongs, high flow oxygen is not at all invasive, yet it clearly serves a life-sustaining role for an increasing number of patients with advanced lung, heart, or cancer-related diseases. Many of these patients would lose consciousness and die within hours or even minutes if their supplemental oxygen was withdrawn."

Advances in medicine have made it so that many more patients with end-stage diseases are living longer, and now the technology is available to provide high flow supplemental oxygen both in the hospital and at home, often providing a limited quality of life for patients. "So this is yet another ethical dilemma in medicine born of technological advancements," adds

Contact: Susanne Hartman
University of Pennsylvania School of Medicine

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