Both Halpern and Hansen-Flaschen have received requests from patients to stop their flow of supplemental oxygen, resulting in death. Halpern first grappled with the difficulty of withdrawing oxygen from an awake and alert patient when, as a first year medical resident, he was treating a hospitalized patient suffering from advanced lung disease and cancer. One morning, the patient said he'd "had enough" and tugged on his mask but was too weak to remove it and asked for Halpern's help to do so. Halpern debated this request with the attending physician who was concerned that the patient would experience air hunger and fear after oxygen was removed, necessitating high doses of sedating drugs. He worried this might constitute a form of euthanasia.

Hansen-Flaschen received a similar request from an outpatient who suffered from an advanced lung disease and was living at home. He could no longer get out of bed and his quality of life had seriously deteriorated. The patient wanted to stop his oxygen therapy and asked Hansen-Flaschen to help him avoid a sense of suffocation afterwards. "I had to ask myself, is this participating in a patient's death or is it simply respecting a patient's request? Plus, there's no way to predict an individual's response to removing supplemental oxygen and how much they will suffer."

Hansen-Flaschen notes "Two-thirds of critical care patients in this country are cared for by general physicians or others without special training in critical care." In light of this, Halpern said he hoped that this commentary "will provide a place for physicians to turn when faced with this particular dilemma. We hope that our recommendations may allow physicians to heed requests for the withdrawal of life-sustaining oxygen as readily as they may heed requests for the withdrawal of other life-sustaining therapies, such as mechanical ventilation and dialysis."

The commentary addresses specific concerns physicians may hav
'"/>

Contact: Susanne Hartman
susanne.hartman@uphs.upenn.edu
215-349-5964
University of Pennsylvania School of Medicine
19-Sep-2006