The following definition for deprescribing can also be applied in principle for withdrawal of treatment: Deprescribing is the systematic process of identifying and discontinuing drugs (treatments) in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual’s care goals, current level of functioning, life expectancy, values, and preferences. 
A shared value-based decision making model (process) for establishing goals of care and special consideration of symptom management and family support during withdrawal of life sustaining therapy is required to ensure the delivery of high quality palliative care. 
Currently, there are no guidelines for the withdrawal of treatment. Most evidence is regarding Intensive Care Unit (ICU) decision-making around withdrawal of ventilation and in people who have a critical illness involving the brain, spinal cord or nerves e.g. stroke, brain injuries and brain death. [1,6]
In the absence of guidelines, the decision to withdraw treatment includes consultation between health professionals, the individual and family. [2,4] Each situation is managed individually and once decisions are made to withdraw treatment, emotional support is an important part of the process for both the person and the family/carers.  Discussions of what might happen after withdrawal, including clear descriptions of withdrawal symptoms, need to be discussed. 
Evidence regarding deprescribing of medications is available. Two articles with strong evidence were reviewed: OncPal, an oncological palliative care deprescribing guideline  and STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy) . The OncPal Deprescribing Guideline validation process demonstrated the incidence of potentially inappropriate medications (PIMs) in palliative cancer patients was high, 70% taking at least 1 PIM, demonstrating the potential benefits for guidelines in clinical practice. 
There were no articles within this search regarding the withholding of nutrition/fluids which indicate a gap in current research.
Most of the systematic reviews were adequate with two that were high quality. In the absence of guidelines, clear and simple communication and psychosocial support are key points in all the review discussions before any decisions are made.
Page updated 24 May 2017