Withdrawing airway or ventilatory support in palliative care
For general advice on decision-making around withdrawing or withholding treatment, see Withdrawing or withholding treatment in palliative care.
When medical complications develop, or patient-determined quality of life deteriorates, airway support (eg endotracheal tube, tracheostomy) or ventilatory support (eg noninvasive ventilation) can be withdrawn and symptom management provided to allow for a comfortable death. Withdrawal of airway support usually occurs in the hospital setting but can occur in any setting with specialist advice and support.
The timing and desire to stop airway or ventilatory support depends on the patient’s clinical situation. Withdrawal can be prompted by a patient’s request, as part of an advance care plan (eg when recognising that the support is no longer helping symptoms or providing a good quality of life), or it may be precipitated by inevitable disease progression and respiratory failure that will lead to death irrespective of airway or ventilatory support.
A patient has the right to request cessation of airway or ventilatory support. Withdrawal of a life-sustaining medical intervention with the informed consent of a patient or their substitute decision-maker is not physician-assisted suicide or euthanasia.
Plan for withdrawal of airway and ventilatory support with the patient, their family and carers, and in consultation with an emergency, respiratory, palliative care or intensive care specialist, to ensure appropriate protocols are followed and distress is minimised.