The difference between withholding and withdrawing life-sustaining treatment

Abstract

This chapter resolves a long-standing debate. It examines what has been called the Equivalence Thesis in respect of withdrawing and withholding life-sustaining treatment (LST). The Equivalence Thesis holds that there is no morally relevant difference between withholding and withdrawing LST: wherever it is morally permissible to withhold LST, it is morally permissible to withdraw LST, and vice versa. Several prominent bioethicists hold the Equivalence Thesis to be true, including John Harris, Dominic Wilkinson and Julian Savulescu. Some of these writers use the Equivalence Thesis to argue for greater rationing in the ICU, with a view to maximising the sum total of lives saved. We argue, however, that the Equivalence Thesis is false, and so cannot be used to support an argument for greater rationing in the ICU. We do not argue against greater rationing, but argue only that the Equivalence Thesis cannot be used to support the case for greater rationing.