Pharmacologic Paralysis and Withdrawal of Mechanical Ventilation at the End of Life

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Abstract
The right of a patient or surrogate to refuse life-sustaining treatment, including mechanical ventilation, is firmly established in American law and bioethics.1 Moreover, practice standards now encourage clinicians to administer sedatives and analgesics in doses that fully relieve the pain and suffering of terminally ill patients, including patients from whom life support is being withdrawn.2 In addition to receiving these medications, however, some patients from whom mechanical ventilation is being withdrawn have been receiving or are given neuromuscular blocking agents at the time of death. By blocking neuromuscular transmission, these agents cause paralysis until they are metabolized or their action . . .