A Costly Separation Between Withdrawing and Withholding Treatment in Intensive Care

Overview

Journal Bioethics

Specialty Medical Ethics

Date 2012 Jul 6

PMID 22762352

Citations 23

Authors

Dominic Wilkinson

Julian Savulescu

Affiliations

Soon will be listed here.

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.

Citing Articles

Withdrawing versus Withholding Treatments in Medical Reimbursement Decisions: A Study on Public Attitudes.

Strand L, Sandman L, Persson E, Andersson D, Nedlund A, Tinghog G Med Decis Making. 2024; 44(6):641-648.

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Is a larger patient benefit always better in healthcare priority setting?.

Sandman L, Liliemark J, Gustavsson E, Henriksson M Med Health Care Philos. 2024; 27(3):349-357.

PMID: 38822945 PMC: 11310225. DOI: 10.1007/s11019-024-10208-9.

Time-Limited Trials for Patients With Critical Illness: A Review of the Literature.

Kruser J, Nadig N, Viglianti E, Clapp J, Secunda K, Halpern S Chest. 2023; 165(4):881-891.

PMID: 38101511 PMC: 11243441. DOI: 10.1016/j.chest.2023.12.014.

Limitation of Non-Beneficial Interventions and their Impact on the Intensive Care Unit Costs.

Koutsouki S, Kosmidis D, Nagy E, Tsaroucha A, Anastasopoulos G, Pnevmatikos I J Crit Care Med (Targu Mures). 2023; 9(4):230-238.

PMID: 37969880 PMC: 10644299. DOI: 10.2478/jccm-2023-0028.

End of life care in the setting of extreme prematurity - practical challenges and ethical controversies.

Wilkinson D, Bertaud S Semin Fetal Neonatal Med. 2023; 28(4):101442.

PMID: 37121832 PMC: 10914670. DOI: 10.1016/j.siny.2023.101442.

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