Question

Withholding treatment means not starting, Withdrawing treatment means stopping something that was already begun. Do you believe that there is any ethical distinction between these two approaches to end-of-life. If you do, please describe what you see as the ethical distinctions, how is it different to stop a treatment rather than not start it?

Answer 1

End of life decision making involves addressing many ethical issues by a healthcare provider. He may choose to withhold treatment or may withdraw the treatment that the patient is already getting. Bioethicists have differing views about the ethics involved here.
✓ethicists in the West do not believe in any ethical distinction between these two approaches.

✓ I ,however, consider some arguments that favour distinction between the two -

A) WITHDRAWING TREATMENT -
✓ refers to stopping the therapy that was sustaining the patient's life
✓The therapy was started with an intention to save the patient's life. But , the treatment must be withdrawn if the physician feels there are no chances of recovery.
✓ if withdrawing treatment is not considered , then all the hospitals would be filled with such terminally ill patients
✓ Not withdrawing treatment , although poses a moral dilemma , itself violates many ethical principles -
• Autonomy - treatment is not going to provide autonomy to the patient. He is just on artificial support systems
• Beneficence - Continuing treatment would be a wastage of limited resources and is benefitting no one.
• Justice - wasting resources on hopeless cases is an injustice to patients who can be cured with these resources.
✓ before withdrawing treatment , a physician tries all his competency and resources to save the patient's life. But, if he feels that despite his best efforts, the patient cannot be saved, it is best to withdraw treatment.

B) WITHHOLDING TREATMENT -
✓ indicates no therapeutic measures will be taken to cure the patient
✓ It implies that in this situation the patient has to surely die
✓ it can be justified in cases where the patient has no hopes of getting a cure by any treatment.
✓ a competent physician have to take such decisions ,if he feels that there is no hope.
✓ It is crucial to inform the family about all aspects of treatment in this situation. The family must be educated about the disease, nature of treatment, futility of care provided ,etc.

Ethical distinction between both these approaches is a complex question. It is morally difficult for the physician to withdraw the treatment rather then withholding the treatment .
Although, both approaches result in similar result,i.e., death , practically a patient should get a chance to get his life saved and later, it may be withdrawn if there is no hope.