Does Care Continue When Treatment Ends?

“Examined Lives: Withdrawing care in the ICU” is a powerful and highly recommended essay with valuable insight about the point at which it becomes clear to the medical care team that a patient is beyond therapeutic or curative efforts.

That it comes from an intensive care nurse makes it that much more valuable, as the ICU nurse is most closely connected to the patient in the bed, and perhaps understands better than anyone, even the physician, the patient’s status is in the transition from life to death.

And yet a word choice by the author, used in the headline and throughout the piece, somewhat undercuts the message for me: “withdrawing care.”

“Intensive care is the place where we hold back death after an acute illness or injury, largely by breathing for patients with machines and by stabilizing their vital signs with a host of powerful drugs,” the nurse and author, Kristen McConnell, writes. “Some patients do well and recover, others can’t, and sometimes a patient’s family realizes that his health won’t meaningfully improve, or that he would not want to live in his condition, and decides to withdraw care. The first time I saw this was haunting.”

But isn’t treatment what is being withdrawn in such a case? Isn’t care the reason such treatment is being withdrawn? Doesn't care continue until the patient is gone, and even afterwards? Isn’t it care that allows a person to die in relative peace? 

McConnell herself seems to get this, as she writes of a dying patient: “The doctor put in orders to withdraw care and discontinue the medications, but I wanted to wait until the tube was actually out before stopping those, because I didn’t want him to die while he still had a plastic tube taped to his face and snaking down his throat, pushing air into his lungs.”

In this case, a tube -- a treatment -- was withdrawn, while care continued. 

This may seem the niggling point of a copy editor, and yet maybe understanding the difference between treatment and care, and not using them interchangeably, is what has earned palliative care specialists such a good reputation in end-of-life medical practice.