• Open Access

A Costly Separation Between Withdrawing and Withholding Treatment in Intensive Care


  • Dominic Wilkinson,

    Corresponding author
    1. Women's and Children's Hospital, Adelaide
    • Dr. Dominic Wilkinson, Discipline of Obstetrics and Gynecology Women's and Children's Hospital University of Adelaide 72 King William Rd North Adelaide SA 5006 Australia. Tel: +61 (0) 8 8161 7631, Fax: +61 (0) 8 8161 7654. Email: dominic.wilkinson@adelaide.edu.au

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  • Julian Savulescu

    1. University of Oxford, St Cross College, Oxford, and Oxford Uehiro Centre for Practical Ethics and Oxford Centre for Neuroethics
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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.