Withholding and withdrawing life-sustaining treatment are not morally equivalent

Dr Andrew McGee1, Dr  Drew Carter2

1Australian Centre for Health Law Research, QUT, Brisbane, Australia, 2Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, Australia

This presentation 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.


Dr Andrew McGee is a moral philosopher and legal scholar with expertise in bioethical controversies, especially at the end of life. He was admitted to practice as a lawyer to the Supreme Court of Queensland and the High Court of Australia in 2006. He holds a PhD in philosophy from the University of Essex, and is currently Senior Lecturer in the Faculty of Law, QUT.

Dr Drew Carter is a moral philosopher and health policy researcher. He applies the work of Ludwig Wittgenstein to illuminate bioethical issues, especially relating to resource allocation.  He has published on assisted reproductive technology and pain.  His current research focuses on intensive care triage and the managed entry of health technologies.

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