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Withdrawing or Withholding Treatment

The primary goal of medical treatment is to benefit the patient by restoring or maintaining the patient's health as far as possible, maximising benefit and minimising harm. However, if treatment fails, or ceases, to give a net benefit to the patient (or if the patient has competently refused the treatment), the primary goal of medical treatment cannot be realised and the justification for providing the treatment is removed. Unless some other justification can be demonstrated, treatment that does not provide net benefit to the patient may, ethically and legally, be withheld or withdrawn and the goal of medicine should shift to the palliation of symptoms.

Most ethicists argue that withholding and withdrawing treatment are equally ethical and justifiable. In countries such as the USA and Great Britain they also are are legally equal.

Treatment should never be withheld, when there is a possibility that it will benefit the patient, simply because withholding is considered to be easier than withdrawing treatment. Although emotionally it may be easier to withhold treatment than to withdraw that which has been started, there are no legal, or necessary morally relevant, differences between the two actions.

Treatments should not be withheld because of the mistaken fear that if they are started, they cannot be withdrawn. This practice would deny patients potentially beneficial therapies. Instead, a time-limited trial of therapy could be used to clarify the patient's prognosis. At the end of the trial, a conference to review and revise the treatment plan should be held. Some health care workers or family members may be reluctant to withdraw treatments even when they believe that the patient would not have wanted them continued. The physician should prevent or resolve these situations by addressing with families feelings of guilt, fears, and concerns that patients may suffer as life support is withdrawn.

Adapted from:
Withholding and Withdrawing Life-prolonging Medical Treatment: guidance for decision making, British Medical Association
Position Paper -- American College of Physicians -- Ethics Manual, Fourth Edition, Annals of Internal Medicine, American College of Physicians.
Spanish Translation Manual de ƒtica Cuarta Edici—n ACP
Patient Refusal of Nutrition and Hydration. Ira R. Byock, American Journal Hospice & Palliative Care, March/April 1995.