A Costly Separation between Withdrawing and Withholding Treatment in Intensive Care

11 Pages Posted: 21 Feb 2014  

Julian Savulescu

University of Oxford - Uehiro Centre for Practical Ethics

Dominic Wilkinson

University of Adelaide - Discipline of Obstetrics and Gynecology

Date Written: March 2014

Abstract

Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life‐sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non‐equivalence, and find only relatively weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non‐equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time‐limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions.

Keywords: intensive care, withholding treatment, medical ethics, health care rationing, resource allocation

Suggested Citation

Savulescu, Julian and Wilkinson, Dominic, A Costly Separation between Withdrawing and Withholding Treatment in Intensive Care (March 2014). Bioethics, Vol. 28, Issue 3, pp. 127-137, 2014. Available at SSRN: https://ssrn.com/abstract=2399252 or http://dx.doi.org/10.1111/j.1467-8519.2012.01981.x

Julian Savulescu

University of Oxford - Uehiro Centre for Practical Ethics ( email )

10 Merton Street
Oxford OX1 3JP
United Kingdom
+44 1865 276926 (Phone)
+44 1865 276932 (Fax)

HOME PAGE: http://www.practicalethics.ox.ac.uk/juliansavulescu.html

Dominic Wilkinson

University of Adelaide - Discipline of Obstetrics and Gynecology ( email )

72 King William Rd
North Adelaide SA
Australia

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