The Window of Opportunity for Treatment Withdrawal

Neonatal hypoxic-ischaemic encephalopathy: most deaths followed end-of-life decisions within three days of birth

“…Although the period of time examined corresponds mainly to the prehypothermia era, the rate of EoL decisions (94%) is in agreement with the figures reported in recent studies and in the cooling trials . The present data are also consistent with EoL practices reported in the first decade of the 21st century in European countries . As in other studies performed in newborns with many diverse conditions, the EoL decision was nearly always based on a poor prognosis .…”

“…Asphyxia is one of the major causes of death in full‐ or near‐term infants . This is the first study providing data of the circumstances surrounding EoL in neonates with HIE after perinatal asphyxia.…”

The ‘window of opportunity’ for death after severe brain injury: family experiences

“…The availability of active euthanasia would mean, as bioethicists (e.g. Savulescu 1994, Wilkinson 2011) have pointed out, that the concept of a ‘window of opportunity’ would become irrelevant, and those who have become aware of it (like those of our interviewees who told us about their ADs) need no longer feel time pressures to refuse LSTs before it becomes ‘too late’. As Cochrane argues: ‘if it were just as easy to “pull the plug” later, most patients would undoubtedly wait for more prognostic certainty’ (Cochrane 2009: W5).…”

“…The research reported here contributes to the medical sociology literature which explores the social construction of death and dying (Kaufman 2005, Kitzinger and Kitzinger, in press) and, more specifically, to the emerging body of clinical and bioethical literature addressing the ‘window of opportunity’ for allowing death (e.g. Crippen 2005, Cochrane 2009, Honeybul et al 2011, Kon 2009, Wilkinson 2011). Bioethicists have extended the concept of the ‘window of opportunity’ (traditionally used within medicine to describe a correlation between prompt treatment and maximised recovery) to describe – and to critique – current medico‐legal practice which results in unnecessary time pressure for allowing death by withdrawal of life‐sustaining treatments.…”

“…Previous work has been philosophical and theoretical (e.g. based on decision theory, Wilkinson 2011) rather than empirical. We have contributed empirical research which addresses some of the key issues that arise for families whose experience of a relative’s severe brain injury is shaped within the medico‐legal concept of the ‘window of opportunity’ for allowing death.…”