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Although the physical process of switching a ventilator off and removing the tracheal tube are simple, there are serious ethical, familial, psychological, religious, and legal considerations of terminal extubation.
In most jurisdictions terminal extubation is not allowed unless patients or surrogate decision makers with power of attorney have explicitly specified that, if care is futile and death imminent, they would want life-support measures withdrawn. If these conditions are met, the patient's family and the health care team may meet to discuss withdrawal of support. Negotiations are made for the timing of extubation and the use of medications or other means to alleviate breathlessness, pain, suffering, and other conditions for withdrawal. Arrangements are made for the funeral and the advisability of or need for autopsy or organ donation. Time is set aside for the family and staff to prepare for death and grieving. Terminal extubation differs from terminal weaning in that the withdrawal of support is sudden. The patient may survive either method of withdrawal for minutes, hours, or, occasionally, days.