Removal of Non-Invasive Ventilation (BiPAP) – What to expect

Why a patient may want to remove BiPAP

Patients with progressive disease involving their respiratory muscles may require Non-Invasive Ventilation (BiPAP) to help with breathing. As the disease advances some patients may decide that they no longer wish to support their breathing with BiPAP, and choose to remove this treatment.

The decision to remove BiPAP is a very personal one.

Some patients will find this decision easy and others may need more time to talk about this with family, friends, their Substitute Decision Maker (SDM) and their health care team.

Talking about BiPAP removal can lead to discomfort and disagreement among a patient’s family, friends and SDM. Have these conversations as early as possible. It is a critical part of the process to remove BiPAP.

Who makes the decision to remove BiPAP? »

A patient or SDM can ask to remove BiPAP. It is both ethical and legal.

If a patient loses the ability and cannot give consent to remove BiPAP, the SDM can make the decision for them.

It is important for patients to talk to their SDM and health care team about their advance care planning decisions and have their wishes to remove BiPAP written down in the patient’s medical record. Patients may also have their decisions documented with the help of a legal professional.

Removal of BiPAP

BiPAP removal can be done in the home, the hospital, Palliative Care Unit or Hospice. Removing BiPAP includes timely use of oxygen and physician-prescribed medications to help with symptoms.

Patients will be made as comfortable as possible. Giving medication to make the person calm and sleepy lowers the level of consciousness with no awareness of voices or pain. Removing BiPAP will end in death. This usually happens within hours, but this timeline can be different for each patient.

Who will be there when BiPAP is removed? »

The patient can decide who they would like by their side at the time when BiPAP is removed. The doctor and Palliative Care Consult Team will also be present throughout the process.

Who will perscribe and give the medications? »

The patient’s admitting doctor, and the Palliative Care Consult Team will order the medications and be available for support.

Prescribed medications will include: opioids and sedatives to manage breathlessness and symptoms. Medication will be given by a physician or nurse. A respiratory therapist will manage the BiPAP settings.

Following removal of BiPAP

Those present for the process may find it emotionally difficult.

Support is available. Patients, family members and friends may wish to speak with the health care team to help plan for this ahead of time.

Frequently Asked Questions

Will removal of BiPAP cause shortness of breath or pain? »

Patients may develop breathlessness (gasping, difficulty breathing) without BiPAP, but may be managed by repositioning. Oxygen may offer some further symptom control (e.g. given to patients via facemask). However, pain is rarely experienced. Medications to help provide comfort during removal of BiPAP may cause drowsiness and sedation. As the process naturally continues, patients may also develop discoloration of their skin.

Is this assisted dying (MAID)? »

No. Removing BiPAP is a decision to stop a medical treatment and allow the underlying condition to take its natural course. Removal of BiPAP results in the person’s death, usually within hours. Medical assistance in dying, or MAID, is different. MAID is a legal end-of-life option in Canada, and is a highly regulated and compassionate procedure that provides patients who are suffering from a life-limiting illness with a measure of control over how and when they will die. For more information you can ask your health care team and visit the Government of Ontario's Ministry of Long-Term Care website.

Location and contact

Palliative care unit admissions (K1E/K1C)

For Palliative Care Unit Referrals.
Please refer to Making A Referral
Phone: 416-480-6182
Fax: 416-480-6118

Palliative care consult team

For inpatient consultations and ambulatory care clinic visits.
Please refer to Palliative Care Consult Team
Phone: 416-480-6100 ext. 67255
Fax: 416-480-5146
Monday - Friday: 8:00 a.m. - 4:00 p.m.

If you have any questions regarding palliative care referrals and resources, please do not hesitate to contact us.

For urgent matters outside of business hours, please call locating at 416-480-4244 and ask the operator to page the "on-call palliative care physician/consultant".

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