Support Withdrawal Causes Most Deaths After TBI

"Although we attribute the variability in withdrawal of life-sustaining therapy to differences in patient preferences, the article by Turgeon and colleagues adds to the growing body of literature that physician practice and the culture of medical centers may play an equally strong role," said Dr. David H. Livingston and Dr. Anne C. Mosenthal.

The way in which physicians manage the uncertainty in predicting recovery from TBI in their discussions with families "may account for a large proportion of variability in outcomes," they wrote. A lot of the uncertainty arises from the "poor discriminatory power of the tools available to measure the extent of brain injury and the lack of outcome data."

Although the report by Dr. Turgeon and coauthors of variable but often early withdrawal "raises the concern of not only hastening death but increasing mortality for patients who might recover with more time," it should be considered at the same time that "allowing patients to linger when death is inevitable is associated with prolonged suffering for both patients and families," Dr. Livingston and Dr. Mosenthal wrote.

Dr. Livingston and Dr. Mosenthal are with the department of surgery at the University of Medicine and Dentistry of New Jersey, Newark. They reported no financial conflicts of interest. These remarks were taken from their commentary accompanying Dr. Turgeon’s report (Can. Med. Assoc. J. 2011 Aug. 29 [doi:10.1503/cmaj.110974]).