Withholding and withdrawing ventilators: a psychological or moral difference?
Andrew McGee1, Queensland University Of Technology 2 Georege St 1Queensland University Of Technology, 2 Georege St, Queensland , Australia
Abstract
Some health ethics writers and clinical guidelines claim that withdrawing and withholding medical treatment are morally equivalent: if one is permissible or impermissible, so too the other.
Call this view Equivalence. It is heir of a related view that has held sway in ethical and legal debate for decades, in support of the withdrawal of treatment that is no longer beneficial. The thinking was that if treatment no longer benefits a patient, then whether it is withheld or withdrawn does not matter – so there is no morally relevant difference between the two.
Equivalence goes beyond this. It applies to beneficial treatment, where two patients compete for one resource. The reasoning is: To save as many lives as possible, we would have no qualms about withholding a beneficial treatment from one person to give it to another who can benefit more. We should therefore have no qualms about withdrawing it either. In this presentation, I argue that Equivalence is false, and cannot be used as an argument against any aversion to withdrawing those who are already receiving life-saving ventilation from the ventilator.
I then argue, however, that this conclusion does not settle the question whether we should withdraw someone from a ventilator to make room for someone who can benefit more. Even if there is a moral difference between withholding and withdrawing a ventilator in these circumstances, there may be other moral reasons that outweigh this moral difference. If there are such reasons, then withdrawing someone from a ventilator to make room for someone who can benefit more may remain justified.
Biography
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