More than half the patients who died in Prince of Wales Hospital's intensive care unit over a two-year period did so after treatment was deliberately withheld or withdrawn to reduce suffering, according to a study. In 90 per cent of such cases, the move was first suggested by doctors, rather than the patient or relatives. Tom Buckley, the hospital's intensive care consultant, said staff were required on an almost daily basis to make decisions about whether to prolong the lives of patients who were 'beyond help'. The withdrawal or reduction of treatment to limit a terminally ill patient's suffering is not illegal. The Medical Council recently issued new guidelines regarding such decisions, saying that should any disputes arise, doctors could seek a court order. The Sha Tin hospital reviewed the cases of 2,649 patients admitted to its intensive care unit between April 1997 and March 1999. Of the 524 who died at the unit, 322 patients, or 61.5 per cent, died after having therapy limited in ways such as reducing the prescription of drugs that maintain blood pressure, limiting oxygen supply or withdrawing dialysis treatment. Only in two cases did doctors unplug life support systems. Dr Buckley said the figures - including the intensive care mortality rate and the proportion of patients receiving limited therapy - were comparable with Western countries. He said that in the United States between 40 and 95 per cent of patients who died in intensive care units had treatment limited. 'When we approach the area of futility, there is a situation that despite all our support, the patient is going to die. One of the side effects of modern intensive care is that we have the ability to prolong the dying process,' he said. 'The medical team will make a consensus and approach the families to say that there is nothing more we can do and therefore we should limit the therapy. Occasionally we are approached by relatives who say, 'Would you please stop'.' The study, the first of its kind in Hong Kong, revealed that patients or their families agreed in 95 per cent of cases to the suggestion that therapy be limited. Only in eight cases did families reject the proposal. Dr Buckley said limitation of therapy had nothing to do with euthanasia because the doctors involved had no intention of killing patients by withholding or withdrawing the treatment. He also emphasised that doctors tried their best to alleviate patients' pain and 'we never limit the treatment because of any perceived lack of resources'. Tim Pang Hung-cheong, spokesman of the Hong Kong Patients' Rights Association, said families must be well informed before making a decision to withdraw treatment.