GESTIÓN EN SALUD PÚBLICA: BioEdge: AJOB debates withdrawing and withholding

domingo, 24 de marzo de 2019

BioEdge: AJOB debates withdrawing and withholding

BioEdge: AJOB debates withdrawing and withholding

Bioedge

AJOB debates withdrawing and withholding

by Michael Cook | 24 Mar 2019 |

The current issue of the American Journal of Bioethics hosts a debate on whether withholding and withdrawing treatment are ethically equivalent. Intuitively most doctors feel that there is a difference between not using the plug and pulling it out – but should that “gut feeling” be respected? Most medical guidelines assume that there is none. For non-bioethicists, the question may seem arcane, but an affirmative answer has momentous consequences, especially in end-of-life care.

On the affirmative side are Dominic Wilkinson and Julian Savulescu, from Oxford University, and Ella Butcherine, from the University of Melbourne. They contend that “withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. They believe that a “preference for withholding over withdrawal could represent a form of cognitive bias” which they describe as “withdrawal aversion”, in other words, an irrational preference for withholding treatment.

On the negative side is Lars Øystein Ursin, of the Norwegian University of Science and Technology. He believes that withholding and withdrawing are not in general ethically equivalent. This means that “medical guidelines should be rewritten, and rather than being ‘educated’ away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment”.

A number of other prominent bioethicists weigh in to the dispute, both for and against. Check it out.

Michael Cook is editor of BioEdge

This is not an appropriate venue for a discussion of my age, but I think that most readers will sympathise with my occasional interest in turning the clock back a few years. What if the hoary adage, "you're only as old as you feel", could have the force of law?

Last year, a flamboyant positivity guru tested this theory in a Dutch court by applying to have his legal age changed from 69 to 49. To no one's surprise, he lost, but the reasoning for the adverse judgement was peculiar (as reported in the media, anyway). The court declared that too much government paperwork depends upon an agreed biological age. At a time when self-identification for gender is widely accepted, this line of reasoning is surprisingly weak.

Which brings me to an intriguing article in the Journal of Medical Ethics (see below) which supports the notion of self-defining age. The author bases it on the need to prevent discrimination on the basis of age, or ageism. I wonder how the courts will respond to this argument.