Categorical Mistakes and Moral Biases in the Withholding-Versus-Withdrawal Debate

Abstract

Lars Ursin gives three reasons why we may not accept the widely held Equivalence Thesis (ET) in bioethics without careful reflection and contextual qualification. First, autonomy can be compromised differently in withdrawal and withholding treatment. Second, professional responsibility may be different as well. Additionally, Ursin also points out that “to continue ongoing treatment has another status for the patient than to embark on a new treatment.” (Ursin 2019)

Dominic Wilkinson, Ella Butcherine, and Julian Savulescu dismiss all three arguments based on the claim that the experienced difference between withholding and withdrawal is based on a cognitive bias they call “Withdrawal Aversion – a non-rational preference for withholding treatment over withdrawal of treatment.” (Wilkinson et al. 2019) To bolster their argument they provide two cases.

However, instead of providing rational arguments strengthening the ET, they appear to weaken ET by biases of their own. Moreover, they tend to support Ursin’s arguments with their cases. Both contributions clearly show that more work is needed. In particular in the field of investigating clinicians’ conceptions of difference in the cases of withdrawal from those of withholding treatment.