Withdrawing life-prolonging treatment not the same as killing

Lawfully allowing a patient to die should be kept distinct from euthanasia. Shutterstock

There is a clear legal distinction in Australia, the United Kingdom, and the United States between withdrawing life-prolonging treatment – such as ventilation for a person who can’t breathe unaided, or artificial nutrition and hydration for those who can’t eat and drink – and euthanasia, a lethal injection or potion.

But philosophers and legal academics disagree. The almost unanimous view is that when doctors withdraw life-prolonging treatment from a patient they are killing her rather than allowing her to die from her underlying condition.

On this basis, they argue the law is incoherent because it prohibits killing by lethal injection or lethal potion, while permitting killing by withdrawing life-prolonging treatment from those dependent on it.

I disagree; withdrawing life-prolonging treatment is not the same as killing.

Bad reasoning? I don’t think so

Australian philosopher and professor of practical ethics at Oxford University Julian Savulescu describes the law’s view that withdrawing a feeding tube is an omission of treatment as “a spectacular example of bad reasoning”.

Similarly, American bioethicists Franklin Miller and Robert Truog have claimed that such a view “flies in the face of a candid look at the facts”.

These claims are used to suggest that the law cannot coherently continue to prohibit euthanasia because it is effectively allowing it to be practised already. On their view, the act of withdrawing a tube is no different from the act of giving a lethal injection.

Miller and Truog claim that it is also incoherent to worry that retrieving organs from willing donors at the end of their lives might cause their deaths, because the law allows doctors to cause their deaths anyway by withdrawing life-prolonging treatment in specified circumstances.

In many instances, treatment merely prevents the patient’s condition taking their life. Shutterstock

Both Savulescu and Miller and Truog make other important arguments about euthanasia and organ donation, some of which are compelling. But their idea that the law is incoherent and propped up by “bad reasoning” is wrong for a number of reasons.

First, they fixate on the act of withdrawing the tube as an act of killing. But withdrawal of the tube is a red herring. In some cases, the tube is left in place for days after feeding stops. And even if the tube is immediately withdrawn, this still comes after feeding ceases. So the act of withdrawing the tube is not the cause of death.

A second reason these ethicists are wrong is that they focus only on the moment of treatment withdrawal, ignoring its initial provision. Since the patient dies when the treatment is withdrawn, we can see why Savulescu and Miller and Truog claim that this kills the patient. But the moment of withdrawal is only on one side of the equation.

The other side of that equation is the fact the patient’s life is being prolonged in the first place. We can only withdraw treatment, and thereby “cause death”, if we started it and prolonged life. We can’t withdraw life-prolonging treatment if we haven’t given it.

So, both sides of the equation are relevant and both sides even one another out. This is why withdrawal is classified in law as letting die rather than killing. We are really allowing the resumption of a process that was already killing the patient.

Controlling the timing of death

We should therefore look at the provision and withdrawal of ongoing life-prolonging treatment as controlling only the timing of the patient’s death, rather than as actually causing the patient’s death.

When we give the treatment in these cases we’re merely preventing the patient’s condition from having lethal effects; the treatment doesn’t cure the patient but simply holds death at bay. Some patients, for example, require ventilators to breathe and can’t be weaned off them, having lost the ability to breathe spontaneously.

There may be cases where we should not allow a patient to die, even though that would not be killing. But lawfully allowing a patient to die should be kept distinct from euthanasia; it really is a form of letting die, whereas euthanasia is a form of killing.

Futher reading: Andrew McGee’s academic papers on the subject are Acting to let someone die (Bioethics) and Does withdrawing life-sustaining treatment cause death or allow the patient to die (Medical Law Review).