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Type: Journal article
Title: A costly separation between withdrawing and withholding treatment in intensive care
Author: Wilkinson, D.
Savulescu, J.
Citation: Bioethics, 2014; 28(3):127-137
Publisher: Blackwell Publ Ltd
Issue Date: 2014
ISSN: 0269-9702
Statement of
Dominic Wilkinson and Julian Savulescu
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
Description: Article first published online: 5 JUL 2012
Rights: © 2012 Blackwell Publishing Ltd. Re-use of this article is permitted in accordance with the Terms and Conditions set out at
DOI: 10.1111/j.1467-8519.2012.01981.x
Appears in Collections:Aurora harvest 4
Obstetrics and Gynaecology publications

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