3. what concern does devettere have with the withdrawal/withholding treatment distinction?

by Lucienne Luettgen I Published 3 years ago Updated 2 years ago

How common are decisions about withdrawing and withholding treatment?

Code of Medical Ethics Opinion 5.3. Decisions to withhold or withdraw life-sustaining interventions can be ethically and emotionally challenging to all involved. However, a patient who has decision-making capacity appropriate to the decision at hand has the right to decline any medical intervention or ask that an intervention be stopped, even ...

Is there an ethical difference between withholding and withdrawing life-sustaining treatment?

Jul 16, 2014 · Abstract. A general rationale is presented for withholding and withdrawing medical treatment in end-of-life situations, and an argument is offered for the moral irrelevance of the distinction, both in the context of pharmaceutical treatments, such as chemotherapy in cancer, and in the context of life-sustaining treatments, such as the ...

What is the difference between withholding and withdrawing?

Apr 21, 2007 · An ethical distinction is drawn between acts and omissions. How this distinction relates to withdrawing and withholding treatment will be considered. Further ethical issues discussed relate to judgements about the futility of treatment, patient autonomy and nurses' duty of care to patients at the end of life.

When should a surrogate make decisions to withhold or withdraw interventions?

Withholding and Withdrawing Treatment. Thanks to recent breakthroughs in medical science and technology, doctors now have available a variety of machines, devices and treatments to keep people alive when an important body system stops working properly. Examples include breathing machines, feeding tubes, CPR and dialysis machines.

How would you differentiate between withholding and withdrawing treatment?

Such decisions can essentially take one of two forms: withdrawing – the removal of a therapy that has been started in an attempt to sustain life but is not, or is no longer, effective – and withholding – the decision not to make further therapeutic interventions.Mar 4, 2005

What is withholding or withdrawing necessary treatment to maintaining life?

Withholding or withdrawing of life-sustaining therapy or life support is a process by which various medical interventions either are not given to or are taken away from patients with the expectation that they will die from their underlying illnesses.

What are the concerns and ethical decisions regarding life sustaining treatment?

The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide.Mar 12, 2021

What is the difference between withholding treatment and euthanasia?

Withdrawal or withholding of treatment is a decision to allow a disease to follow its natural course, which may result in a patient's death. Euthanasia, on the other hand, is a conscious decision to take actions with the specific intent to end a patient's life.

What is withdrawal treatment?

Whether a doctor withholds or withdraws treatment, they are making a decision not to provide treatment and this decision will deprive the patient of the opportunity to survive.

Is there an ethically significant difference between withdrawing treatment so that a patient dies and withholding treatment so that a person dies?

Code of Medical Ethics Opinion 5.3

While there may be an emotional difference between not initiating an intervention at all and discontinuing it later in the course of care, there is no ethical difference between withholding and withdrawing treatment.

Is withdrawal of treatment ethical?

The withdrawal of treatment is one of the most emotionally challenging and ethically complex aspects of end-of-life care. As our ability to prolong life progresses, the necessity to address issues such as the withdrawal of treatment increases in parallel.

Is withdrawal of treatment considered euthanasia?

No. A health professional does not perform euthanasia or physician-assisted suicide by withholding or withdrawing treatment even if that treatment is needed to keep the person alive.

Is there an ethical or legal difference between withholding and withdrawing medically assisted nutrition and hydration?

Although individuals may hold personal or professional reservations, withholding or withdrawing ANH is both legally and ethically permissible.

What is end of life decision?

End-of-life decisions are often associated with the perspective of the respiratory specialist. On one side, the physician may be confronted directly with these decisions regarding their own patients with an end-stage respiratory failure caused by a chronic conditions such as chronic obstructive pulmonary disease (COPD).

What does it mean to be euthanized?

Euthanasia generally means any action or omission that by itself or in its intentions leads to the death of the patient, in order to prevent his/her further suffering.

What is open access?

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author (s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

Abstract

A general rationale is presented for withholding and withdrawing medical treatment in end-of-life situations, and an argument is offered for the moral irrelevance of the distinction, both in the context of pharmaceutical treatments, such as chemotherapy in cancer, and in the context of life-sustaining treatments, such as the artificial ventilator in lateral amyotrophic sclerosis.

Background

End-of-life situations are among the most prominent areas of controversy in contemporary bioethics. To this day, very few countries have taken the radical approach of accepting the direct termination of life by a medical practitioner. Most countries stick to the traditional interdiction of voluntary active euthanasia.

Discussion

Is this general rationale for withholding and withdrawing pharmaceutical treatment in the context of oncologic disease also applicable to life-sustaining medical technology, such as the artificial ventilator in situations in which the patient is unable to breathe spontaneously? In particular, does the moral irrelevance of the distinction between withholding and withdrawing hold in these contexts as well? One possible reason to deny that the moral irrelevance thesis holds with reference to such life-prolonging treatments as artificial ventilation is the fact that, whereas withdrawing chemotherapy in the oncology case does not have a direct, immediate effect on the patient’s life, and may even produce better overall consequences, withdrawing ventilatory support from a patient suffering from LAS, or otherwise unable to breathe spontaneously, has the direct effect of bringing about the patient’s death [ 4 ].

Conclusions

In conclusion, I believe we have quite good reasons for endorsing the interpretation of the moral and legal principles governing the use of life-prolonging means that was sanctioned by both Welby and Englaro cases: to grant patients a consistent opportunity to withhold and withdraw all kinds of medical treatments is in fact to confer them a substantial warrant against the unwanted consequences of medical development and may weaken the drive towards the much more problematic option of changing existing regulations concerning the direct killing of patients..

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

About this article

Reichlin, M. On the ethics of withholding and withdrawing medical treatment. Multidiscip Respir Med 9, 39 (2014). https://doi.org/10.1186/2049-6958-9-39

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