November 30, 2021

AJOB debates withdrawing and withholding

Bioethicists clash over whether they are ethically equivalent

The current issue of the American Journal of Bioethics hosts a debate on whether withholding and withdrawing treatment are ethically equivalent. Intuitively most doctors feel that there is a difference between not using the plug and pulling it out – but should that “gut feeling” be respected? Most medical guidelines assume that there is none. For non-bioethicists, the question may seem arcane, but an affirmative answer has momentous consequences, especially in end-of-life care.

On the affirmative side are Dominic Wilkinson and Julian Savulescu, from Oxford University, and Ella Butcherine, from the University of Melbourne. They contend that “withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. They believe that a “preference for withholding over withdrawal could represent a form of cognitive bias” which they describe as “withdrawal aversion”, in other words, an irrational preference for withholding treatment.

On the negative side is Lars Øystein Ursin, of the Norwegian University of Science and Technology. He believes that withholding and withdrawing are not in general ethically equivalent. This means that “medical guidelines should be rewritten, and rather than being ‘educated’ away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment”.

A number of other prominent bioethicists weigh in to the dispute, both for and against. Check it out.

Michael Cook is editor of BioEdge

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end-of-life care
equivalence theory