Always ask very basic questions (lay man's questions in complex situations)
before withdrawal of support.
1.Always ask are you prolonging Life or prolonging Death ?
2.If you are prolonging life, Does the patient have a Reversible condition? (Ask the specialist)
3.If treated, will it restore the patient to independent existence and a reasonable quality of life.(able to take care of activities of daily living)
( Ask the specialist)
(Good to know, What was the premorbid Quality of life?,If poor makes it easy to consider withdrawal.)
4.Ask the family what would have been patient's wishes under these circumstances regarding life prolonging support and outcome unsure (Check if patient has expressed any wishes before)
5. Discuss openly and Honestly with the Relatives and seek their opinion and express the Medical opinion. Tell them the decision is a medical decision, they don't have to take the burden of making a decision.
If they Object seek a Multi disciplinary/ ethical team /medicolegal involvement.
6.Always ask yourself If it is your own family member what would you have chosen.
7.Always consider providing a dignified death to your patients.
The reality is withdrawal of life care may enter grey areas, where things are not clearly written down.
You really have to fall back on expert Opinion, Your Knowledge and Judgement.
There is always a possibility of your decisions being wrong,Remember even the best medical EVIDENCE on the basis of which we quote outcome have a probability of <5% left to chance.