TY - JOUR T1 - Withdrawal of life-sustaining therapy: the case for delay JF - Emergency Medicine Journal JO - Emerg Med J SP - 203 LP - 204 DO - 10.1136/emermed-2016-206397 VL - 34 IS - 4 AU - Bernard A Foëx Y1 - 2017/04/01 UR - http://emj.bmj.com/content/34/4/203.abstract N2 - To everything there is a season …When should life-sustaining treatment (LST) be stopped? The simple answer is when it is no longer appropriate to continue. This may be when the patient withdraws consent for treatment to continue, or when further treatment becomes futile.But what is futility? “I know it when I see it”, as Supreme Court justice Potter Stewart said in 1964 (in relation to something quite different). In some cases it is indeed easy to recognise. A definition may be more challenging. A treatment may be said to be futile when it will not achieve its stated aim either qualitatively or quantitatively.1 An example of qualitative futility is giving antibiotics for a viral infection. Quantitative futility is, for example, giving ever-increasing doses of norepinephrine to a patient with multiorgan failure, who remains hypotensive and whose lactate is increasing. Quantitative futility has also been defined as a treatment, which has a less than 1 in a 100 chance of success.1In the case discussed by Gardiner et al2 in this journal (ref) there are several rationales for not stopping LST early, namely, Prognostic uncertaintyBrainstem testing as a diagnostic end pointRespect for autonomyUtilitarianism (maximising the good)Each of these deserves some explanation.It is difficult to make predictions, especially about the futureiThe Neurocritical Care Society (NCS) has recommended defining a devastating brain injury (DBI) as, ‘neurological injury where there is an immediate threat to life from a neurological cause’, and, ‘severe neurological insult where early … ER -