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We believe the problem was passive non-response rather than active withholding of consent.
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In the placebo-controlled US301 trial, despite rescue of non-responders on or after 4 months, withholding active treatment for this period resulted in losses of physical function that were not regained when active treatment was initiated [ 42].
With this study, it was not possible to find evidence of the exact reasons for withholding active therapy by only treating patients palliatively.
It only considered preferences regarding withholding active and aggressive interventions while not adjusting for those patients who were receiving those interventions at baseline nor those that later decided to withdraw active interventions.
Many studies had a control group in which active therapy was withheld from participants.
Additionally, it has made it unethical to withhold active therapy and therefore to perform true placebo-controlled clinical trials.
Immediate palliation was defined as the decision to withhold active treatment and to provide palliative care only immediately after ICH diagnosis.
An important limitation of our study is the lack of evidence for the exact reasons to withhold active therapy and to treat palliatively only.
In particular, there appears to be no cogent reason to withhold active therapy for hypertension in persons in their 8th or 9th decades of life, nor to modify the blood pressure thresholds above which treatment is recommended.
The proportion of liveborn babies for whom active stabilisation was withheld at birth decreased with increasing gestation: 73% (111/152) at 22 weeks, 16% (55/338) at 23 weeks, and <2% (23/1535) at 24-26 weeks (table 1).
A young person completing an AD and subsequently taking a paracetamol overdose to ensure active treatment is withheld is therefore not legally binding: this would be euthanasia by omission because death is the intended outcome and not providing treatment facilitates this outcome.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com