Theoretical Medicine and Bioethics

, Volume 40, Issue 1, pp 21–41 | Cite as

Beyond the Equivalence Thesis: how to think about the ethics of withdrawing and withholding life-saving medical treatment

  • Nathan EmmerichEmail author
  • Bert Gordijn


With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously.


Equivalence Thesis Withdrawing Withholding Medical practice Acts and omissions 



This paper was written with the support of ENDCARE, an Erasmus+ funded project on ethics and care at the end of life.


EU ERASMUS+ Programme Agreement No. 2015-1-MT01-KA203-003728: Harmonisation and Dissemination of Best Practice – Educating and alleviating the concerns of Health Care Professionals on the proper practice of end of life care (ENDCARE).


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Medical School, Australian National UniversityCanberraAustralia
  2. 2.Institute of EthicsDublin City UniversityDublinIreland
  3. 3.School of History, Anthropology, Politics and PhilosophyQueen’s University BelfastBelfastUK

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