Death or dying is an inevitable part of the ICU practice. Most deaths we see in the ICU are anticipated or at least somewhat expected. In many cases the patient dies because the treatment has been stopped since there was no hope for meaningful recovery and survival.

I have heard many times people referring to withdrawal of care as “pulling the plug”.
Personally, I do not like this phrase. I consider it somewhat inappropriate and even vulgar. When talking about withdrawal of treatment, I prefer phrases like “letting the patient die in peace, changing the goal of therapy towards comfort, letting nature take it’s course, withdrawing aggressive treatment” etc. Once in awhile, though, in a discussion with the family, somebody would use this exact phrase – “pulling the plug”.

It is not just that it cuts my ear; many people might not even have a very good idea of what it means in the first place.

Pulling the plug means letting somebody die by withholding aggressive treatment. Often, families expect their loved one to die almost immediately after stopping that treatment – just like pulling the plug.

First of all, many patients survive for hours or even days after the aggressive treatment has been stopped. The family should always be prepared for this.

Second, there might not be a “plug” to pull in the first place, if the patient is not receiving aggressive life support or treatment.

One thing that is being closely identified as a “plug to pull” is a ventilator or breathing machine. If the patient is on a ventilator and the family insists on withdrawal of care, the breathing tube is pulled and the ventilator is turned off – the “plug” is pulled. Even though the ventilator is considered to be life support, some patients still survive for some time after it has been removed.

Dialysis for kidney failure is another piece of machinery that is often being identified with the “plug”. Stopping dialysis will eventually lead to the patient’s death, but the process of dying might take several days or even longer.

In many cases, the patient is not on a ventilator or dialysis machine. There is no physical switch to turn or plug to pull. If withdrawal of treatment and comfort care is considered by the family and is in the patient’s best interests, in actuality the feeding tube might be the only thing that is keeping the patient alive.