Withdrawing Patients Treatment: Is It Justifiable?
Treatment withdrawal is common in critical care, where patients get exhausted with interventions that do not lead to improvement or recovery. While both healthcare providers and patients can choose to stop the therapy, the decision is challenging following the impact of legal and ethical principles (Lyu & Zhang, 2018, p. 312). Treatment withdrawal is a life and death matter that appeals to society’s ethics and legal frameworks based on the value of life and protection that the government provides. The action can lead to patients’ death in terminal illnesses and complications against society and the government’s wish. However, such withdrawals are beneficial to save costs, pain, and stress. Healthcare providers, regulatory bodies, and governments have developed frameworks that can guide decision-making to ensure appropriate decisions following the opposing interests. Through healthcare ethical principles and legal guidelines, practitioners can justify the withdrawal of patient treatment in some situations. This paper explores various ethical principles and legal procedures to show conditions and ways to treat as justifiable.
Healthcare providers can legally and ethically withdraw treatment when it has no medical benefits to the patient. The treatment goals include to palliate symptoms, improve functional performance, prevent diseases and complications or cure. Consequentialism and classical utilitarianism models define narrow down the goals by stating that the best action is one with maximum utility, including happiness, benefits, welfare, and less pain (Roberts & Reich, 2002, p. 1057). Subsequently, a treatment that is out of the medical goals has minimal utility to patients and their families (Rodger & Blackshaw, 2017, p. 559). Following the consequentialism principle, it would be immoral for a doctor to sustain the treatment in such a case because the consequences are negative (Herring, 2018, p. 13). Withdrawing the therapy leads to positive outcomes by ending pain, suffering, and high cost compared to sustaining the treatment that persists low quality of life against medical and nursing goals. However, the move sometimes appears as injustice when compared to cultural practices that value human life.
Although healthcare providers are justifiable to withdraw treatment when it is not beneficial, a challenge arises on justice and responsibility for the community on practices about life. Society values life, and there is a rule not to kill or compare life with anything else on earth, including money. While withdrawing treatment provides utility to the patient, it has no benefit to society following the rule of thumb about life. People would decide to see their friends and relatives longer despite the cost. Going against such commonly accepted law would be an injustice and, therefore, unjustifiable action of withdrawing patient therapy (Gillon, 1994, p. 185). The community is a potent source of morality and contains the most significant number of people than the single patient, leading to justice in such a case. However, practitioners would still justify withdrawing treatment through the act of utilitarianism.
Healthcare providers can justify withdrawing treatment when it is not medically beneficial through utilitarianism, allowing one to assess actions in complex situations with conflicting moral obligations. Savulescu and Wilkinson (2019, p. 68) refer to Richard Hare, a famous utilitarian who proposes act utilitarianism in conflicting cases to select the correct rule to guide practice. In act utilitarianism, morally right actions are those with more net utility, patient well-being compared to other benefits such as justice to the whole community (Mokriski, 2020, p. 261). In such a case, the best rule to apply is maximizing patient good instead of community morality or law. As a result, medical can justify withdrawing patient Treatment when not beneficial through act utilitarianism that prioritizes patient outcomes before community rules.
Again, a physician withdrawing treatment would be justified based on community rule and moral obligation of justice. According to the principle of justice, all society members should have equal benefits to health or share sufferings (Pratt et al., 2020, p. 3). In healthcare, providers are supposed to be fair to patients and the community, following the relationship across all people about public health (Childress, 2012, p. 67). Public health is the responsibility of all community members, government, and healthcare providers to ensure safety and recovery. Scully (2004, p. 652) points out that some diseases are not worth investing public money and time since they do not add to overall community health. Such illnesses, which have no medical benefits through any treatment, do not serve the community and waste health resources concerning justice. Keeping a patient who will not recover or improve symptoms is a waste of opportunity to improve overall community health. Fairness is where such patients allow other people with the potential to enhance the use of the treatment. As a result, withdrawing patient Treatment would be justifiable through justice in public health if there is no expected improvement.
Similar to the above argument, healthcare providers would show that the practice of withdrawing therapy is morally right through the principle of beneficence that seeks to promote social welfare. Under the model, all professionals are supposed to do good to others through acts of kindness, charity, and mercy, and following moral obligation (Bayer & Fairchild, 2004, 481; Nordenfelt, 1986, p. 283). In the current topic under discussion, moral obligation to serve public health through increased access justifies therapy withdrawal (Knickman et al., 2016, p. 1647). Healthcare providers are responsible for developing systems and continuous improvement to improve care quality, including access. Patients who continue receiving treatment without hope of recovery or improvement blocks others who would benefit through health or improvement. Maintaining such clients to therapy fails to serve the moral obligation of increasing access.
Additionally, healthcare providers would not be merciful to other sick people queuing while creating opportunities by stopping treatment for those who cannot recover or improve. Healthcare workers would use goodwill to show that withdrawing Treatment that lacks medical benefit is suitable to improve public health through increased access. The principle proposes serving public interest before that of a patient who cannot recover but build pressure on resources (O’brien & Chantler, 2003, p. 37). As a result, the beneficence principle combines with others such as justice to justify withdrawing patient Treatment by arguing lack of medical benefits and benefit to the community.
In the same way, virtue ethics justifies withdrawal of treatment where such therapy does not help the patient overcome pain, symptoms, or heal. Virtue ethics argues that actions are good when they appeal to ideal characters in a given situation (Stuart, 2000, p. 51). For example, models under the theory, ethics of care, support more famine, including caring, compassion, and kindness instead of having universal practices. The community appreciates and finds such characters morally upright since they support overall good to other people (Bäckryd, 2019, p. 71). People would appreciate healthcare workers who get a better way of ending patient pain and stressful life with no chances of recovery following their empathetic nature (Papouli, 2019, p. 922). Sick people in pain and minimal chances of recovery stresses the community, which shares the burden following the connection between souls. As a result, healthcare providers would justify their actions to stop treatment for patients who would not recover under community appreciation of virtues.
Contrary to virtue ethics, justice, and beneficence principles, the need for consent would challenge justification of treatment withdrawal even where there are no medical benefits. The demand for support on any treatment action over the patient is a strategy to ensure the right to freedom in decision-making about self (James et al., 2019, p. 5). Healthcare providers are supposed to seek permission from their clients to administer or withdrawal any treatment as a show of respect for other people’s autonomy. The law and moral ethics require that healthcare providers serve patients’ best interests through shared decision-making (Whitney, 2003, p. 278). Options to stop or proceed with therapy require consultation with the patient regardless of the benefits in whichever approach partitioners think proper. As a result, healthcare providers would justify the withdrawal of treatment with no medical services when there is consent from the patient.
However, the justification through consent would not be enough where patients are incapable of making decisions which align with their interest. Healthcare providers are responsible in such a case to ensure client support in consenting (Savulescu & Momeyer, 1997, p. 285. Such support can include providing information about the contested action and outcomes and the inclusion of a family member to represent the patient (Cave, 2014, p. 106). In the case of supported consent through shared decision-making, healthcare providers need to show that their actions serve patients’ bests interests. Therefore, withdrawing unbeneficial treatment where patients lack the capacity to consent would still be justifiable where healthcare providers prove that they did the client’s interests.
Another ethical and legal dimension in justifying withdrawal or sustained of therapy or not is where patients do not want to proceed with the treatment. Medical providers can or cannot legally and ethically withdraw therapy in such a case depending on different factors. According to the autonomy principle of moral reasoning, healthcare providers have to respect patients over decisions on their own body and life (Beauchamp & Childress, 2013, p. 58). The principle informs that patients can refuse treatment, and providers must respect the decision. Allowing patients to decide over their healthcare supports human dignity where people play roles in determining their policies and goals (Motloba, 2018, p. 420). Autonomy is a natural law which whose respect implies morally good medical practice. The law also protects people against interference with their autonomy since human rights guarantee freedom in making personal decisions, including individual health (Coggon & Miola, 2011, p. 525). According to the principle of autonomy and the right to self-determination, healthcare providers are morally and legally right to withdraw treatment whenever patients refuse.
A challenge might arise inappropriateness of withdrawing treatment with a patient request where the outcomes affect public health and risk other people’s lives. Some illnesses, for instance, tuberculosis, are contagious, and failed treatment can affect other people. A dilemma arises on which ethic to follow between providing for the patient right to self-determinism, which holds moral and ethical obligation, or protecting the community, which is a moral duty for healthcare providers (Coggon & Miola, 2011, p. 525; Lindberg et al., 2019, p. 163). Medical practitioners can use Mill’s harm principle to justify withdrawing or sustaining treatment despite patients’ decisions. According to Mill, healthcare providers can exercise power against patients’ wishes only where such decisions protect others from harm (Upshur, 2002, p. 102). The principle guides on prioritizing public health before serving a patient’s self-determinism. Healthcare providers are right to stop the treatment where their clients request if there is no danger of spreading the illness to others. Patient’s rights to self-determinism operate within the limits of the community where people’s actions should not harm others (Gostin & Gostin, 2009, p. 215). Therefore, healthcare providers can justify the withdrawal of Treatment through Mill’s harm principle alongside autonomy ethics.
Again, withdrawing treatment with patients’ request and wish raises another ethical issue on the ability to consent and outcomes that might challenge the justification. Authorization allows patients to enjoy their right to autonomy by participating in decision-making about their lives (Chartrand, 2018, p. 9). Request or demand to withdraw treatment involves consent because patients make decisions about their lives. Healthcare providers complete the support when they serve patient wishes (O’Neill, 2003, p. 5). Where clients consent, and there is no harm to the public, for instance, the risk to infections, healthcare providers can justify their action to stop therapy. However, one might wonder whether justification through consent would hold where stopping therapy hurts the patient.
Despite the justification through consent, providers would not have a defense to withdraw treatment where patients suffer, for example, death or other complications. According to Herring (2018, p. 150), it is a criminal offense where doctors hurt patients even with consent. Stopping treatment comes with consequences such as death, where practitioners remove lives saving machines or dialysis systems. Doctors are liable for the outcomes because they have to protect patients. According to the non-maleficence principle, healthcare providers should not harm and protect patients from harm resulting from neglect (Holland, 2015, p. 160). Accordingly, harmful actions of withdrawing treatment with adverse effects are neglect even where there is consent. Healthcare providers are aware that such actions will lead to negative outcomes and guide patients towards making the right decision instead of supporting wrong choices (Parens, 2015, p. 18). As a result, it is not legally and ethically justifiable to withdraw treatment with consent where such action leads to harm on patients.
In contrast, healthcare providers might find it hard to defend decisions to stop treatment where patients cannot consent despite their explicit or implicit communication about the move. Consent can sometimes be incomplete where patients are incompetent, uninformed, or coerced to accept treatment withdrawal (Chartrand, 2018, p. 9). Healthcare providers who accept to withdraw treatment from patients who cannot consent do not support autonomy. According to beneficence, healthcare providers have a moral obligation to defend and protect patients’ rights (Seay & Nuccetelli, 2017, p. 122). Nurses and other practitioners should take any action to ensure benefits to patients and make recommendations on treatment with intentions to maximize patient well. The community trusts that healthcare practitioners will guide them towards the best care through shared decision-making. Therefore, it would not be justifiable to stop therapy through patient choice where such people cannot agree.
In conclusion, healthcare providers can justify the withdrawal of patient treatment in some situations and where they serve the legal and moral principles while following the pessary guidelines. Analysis of legal and ethical principles shows that stopping therapy, where it does not help medical goals, including healing and symptoms improvement, serves the community through reduced pressure of healthcare resources. The action is also justifiable under beneficence in that healthcare providers would reduce pain and stress related to treatment that does not benefit the patient. However, there are challenges such as the need for informed consent and opposition from the community rule of respecting lives. Withdrawing treatment would still be justifiable where physicians serve the client’s interests and the significant utility of underacting utilitarianism. It would also be justifiable to withdrawal patient treatment with requites from the affected individuals following the principle of consent that requires respect of personal choices. However, healthcare providers would have to show that the consent process was appropriate and not hurt the patient.
Bäckryd, E. (2019) ‘Nurturing the virtues: upholding professionalism in the midst of busy medical practice.’ Journal of Continuing Education in the Health Professions, 39(1), pp.69-72. Web.
Bayer, R. and Fairchild, A.L. (2004). ‘The genesis of public health ethics.’ Bioethics, 18(6), pp.473-492. Web.
Beauchamp, T.L. and Childress, J.F. (2013). Principles of Biomedical Ethics. 7th ed. Oxford University Press, USA. Web.
Cave, E. (2014). ‘Goodbye Gillick? Identifying and resolving problems with the concept of child competence.’ Legal Studies, 34(1), pp.103-122. Web.
Chartrand, L. (2018). ‘Individualism and the decision to withdraw life support.” Societies, 8(4), p.117-125. Web.
Childress, J.F. (2012). ‘A principle-based approach,’ in Kuhse, H. and Singer P. (eds) (2012) A Companion to Bioethics. 2nd ed. Oxford: Web.
Coggon, J. and Miola, J. (2011). ‘Autonomy, liberty, and medical decision-making.’ The Cambridge Law Journal, 70(3), p.523-547. Web.
Gillon, R. (1994). ‘Medical ethics: Four principles plus attention to scope.’ Bmj, 309(6948), p.184-188. Web.
Gostin, L.O. and Gostin, K.G. (2009). ‘A broader liberty: JS Mill, paternalism and the public’s health.’ Public Health, 123(3), pp.214-221. Web.
Herring, J. (2018) Medical law, and ethics. 7th ed. Oxford: Oxford University Press.
Holland, S. (2015). Public health ethics. 2nd ed. London: Polity. Web.
James, J.T., Eakins, D.J. and Scully, R.R. (2019). ‘Informed consent, shared-decision making, and a reasonable patient’s wishes based on a cross-sectional, national survey in the USA using a hypothetical scenario.’ BMJ open, 9(7), 1-7. Web.
Knickman, J., Krishnan, R. and Pincus, H. (2016). ‘Improving access to adequate care for people with mental health and substance use disorders.’ Jama, 316(16), pp.1647-1648. Web.
Lindberg, J., Johansson, M. and Broström, L. (2019). ‘Temporising and respect for patient self-determination.’ Journal of medical ethics, 45(3), pp.161-167. Web.
Lyu, C. and Zhang, L. (2018). ‘Who decides in withdrawal of treatment in a critical care setting? A case study on ethical dilemma.’ International journal of nursing sciences, 5(3), pp.310-314. Web.
Mokriski, D. (2020). ‘The eligibility of rule Utilitarianism.’ J. Ethics & Soc. Phil., 17, p.259-270. Web.
Motloba, P.D. (2018). ‘Understanding of the principle of Autonomy (Part 1).’ South African Dental Journal, 73(6), pp.418-420. Web.
Nordenfelt, L. (1986). ‘Health and disease: Two philosophical perspectives.’ Journal of Epidemiology and Community Health, 40(4), p.281-284. Web.
O’brien, J. and Chantler, C. (2003). ‘Confidentiality and the duties of care.’ Journal of medical ethics, 29(1), pp.36-40. Web.
O’Neill, O. (2003). ‘Some limits of informed consent.’ Journal of medical ethics, 29(1), pp.4-7. Web.
Papouli, E. (2019). ‘Aristotle’s virtue ethics as a conceptual framework for the study and practice of social work in modern times.’ European Journal of Social Work, 22(6), pp.921-934. Web.
Parens, E. (2015). ‘Drifting away from informed consent in the era of personalized medicine.’ Hastings Center Report, 45(4), pp.16-20. Web.
Pratt, B., Wild, V., Barasa, E., Kamuya, D., Gilson, L., Hendl, T., and Molyneux, S. (2020). ‘Justice: A key consideration in health policy and systems research ethics.’ BMJ Global Health, 5(4), 1-9. Web.
Roberts, M.J. and Reich, M.R. (2002). ‘Ethical analysis in public health.’ The Lancet, 359(9311), pp.1055-1059. Web.
Rodger, D. and Blackshaw, B. (2017). ‘An introduction to ethical theory for healthcare assistants.’ British Journal of Healthcare Assistants, 11(11), pp.556-561. Web.
Savulescu, J. and Momeyer, R.W. (1997). ‘Should informed consent be based on rational beliefs?’ Journal of medical ethics, 23(5), pp.282-288. Web.
Savulescu, J. and Wilkinson, D. (2019). ‘Consequentialism and the law in medicine.’ Philosophical Foundations of Medical Law, p.68. Web.
Scully, J.L. (2004). ‘What is a disease? Disease, disability, and their definitions.’ EMBO reports 5(7), pp.650-653. Web.
Seay, G. and Nuccetelli, S. (2017). Engaging Bioethics: An introduction with case studies. Taylor & Francis.
Upshur, R.E. (2002). ‘Principles for the justification of public health intervention.’ Canadian journal of public health, 93(2), pp.101-103. Web.
Whitney, S.N. (2003). ‘A new model of medical decisions: Exploring the limits of shared decision making.’ Medical Decision Making, 23(4), pp.275-280. Web.