Yogyakarta, February 24th 2026 — Decisions to discontinue ventilators, taper vasopressor medications, or discharge patients in extremely critical conditions are not merely technical clinical actions. In intensive care units, such decisions often fall into a gray area between family expectations, medical limitations, and the absence of strong, specific regulations concerning end-of-life care.
A research team from the Graduate School of Universitas Gadjah Mada (SPs UGM), led by Prof. Dr. apt. Sismindari, S.U., demonstrates that palliative care and bioethical frameworks can help healthcare professionals, patients, and families make more humane and well-directed decisions.
“A palliative approach does not mean giving up; rather, it ensures that every decision continues to respect the patient’s dignity and minimize suffering,” said Prof. Sismindari.
The study, funded from the UGM Graduate School Research Grant 2025, examined two cases of elderly male patients with severe cervical spinal cord injuries treated at a teaching hospital in Yogyakarta. Both experienced extensive paralysis and ventilator dependence before eventually passing away at home.
The first case reflected an aggressive treatment pattern involving multiple invasive interventions, despite minimal neurological prospects for recovery. A palliative framework was not explicitly applied, and therapeutic goals remained curative-oriented. In contrast, the second case implemented a pro-palliative approach from the outset. The intensive care team collaborated with the palliative team and a case manager to prepare a high-risk discharge plan, train family members, and carefully consider clinical, social, and spiritual aspects in every decision.
Comparison of the two cases showed that a clear palliative framework helps clinical teams assess the proportionality of medical interventions. Infections and symptoms were still treated, but invasive procedures that no longer provided meaningful benefit could be avoided. This approach reduced the risk of overtreatment that might prolong suffering.
Methodologically, the research employed an empirical ethics approach with medical record analysis and interviews with healthcare professionals and patients’ families. The findings revealed that decisions to withhold or withdraw life-sustaining treatment often create confusion and moral distress among healthcare workers without support from clear ethical guidelines.
This study aligns with SDG 3 (Good Health and Well-Being) and SDG 16 (Peace, Justice, and Strong Institutions). The recommendations include early referral to palliative teams, structured family meetings, strengthening the role of ethics committees, and developing written guidelines on withholding and withdrawing life-sustaining treatment.
The research underscores that sustainable development also involves how health systems ensure a dignified end-of-life experience for every individual.
Source: Sismindari
Editor: Asti Rahmaningrum
Photo: RN.com