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Current controversy
Is withdrawing treatment really more problematic than withholding treatment?
  1. James Cameron1,2,
  2. Julian Savulescu1,2,3,
  3. Dominic Wilkinson2,3,4
  1. 1 Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
  2. 2 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  3. 3 Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
  4. 4 Newborn Care, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to James Cameron, The University of Melbourne Melbourne Law School, Carlton, VIC 3053, Australia; jamesamcameron{at}gmail.com

Abstract

There is a concern that as a result of COVID-19 there will be a shortage of ventilators for patients requiring respiratory support. This concern has resulted in significant debate about whether it is appropriate to withdraw ventilation from one patient in order to provide it to another patient who may benefit more. The current advice available to doctors appears to be inconsistent, with some suggesting withdrawal of treatment is more serious than withholding, while others suggest that this distinction should not be made. We argue that there is no ethically relevant difference between withdrawing and withholding treatment and that suggesting otherwise may have problematic consequences. If doctors are discouraged from withdrawing treatment, concern about a future shortage may make them reluctant to provide ventilation to patients who are unlikely to have a successful outcome. This may result in underutilisation of available resources. A national policy is urgently required to provide doctors with guidance about how patients should be prioritised to ensure the maximum benefit is derived from limited resources.

  • allocation of healthcare resources
  • criminal law
  • clinical ethics
  • decision-making
  • distributive justice

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There are no data in this work.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/medethics-2020-106330

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    Data availability statement

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    Footnotes

    • Twitter @Neonatalethics

    • Contributors JS and DW conceived of the idea and edited the manuscript. DW drafted the outline. JC drafted the legal section and drafted the ethics section. All authors approved the final version. Each author contributed to the design, research, drafting and revision of this manuscript.

    • Funding This work was supported by the Wellcome Trust, grant number WT203132 to Julian Savulescu, Dominic Wilkinson, and James Cameron, and grant number WT104848 to Julian Savulescu, and Victorian Government’s Operational Infrastructure Support Program to Julian Savulescu and James Cameron.

    • Disclaimer The funder had no role in the preparation of this manuscript or the decision to submit for publication.

    • Competing interests DW was a co-author of the British Medical Association COVID-19: ethical issues document and is a member of the British Medical Association Medical Ethics Committee.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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