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Withholding & Withdrawing Care: Autonomy & Surrogate Decision Makers

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  • 0:00 Medical Ethics
  • 0:53 Withholding vs.…
  • 2:33 Autonomy & Surrogate…
  • 5:18 Lesson Summary
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Lesson Transcript
Instructor: Christopher Muscato

Chris has a master's degree in history and teaches at the University of Northern Colorado.

In this lesson, explore the concepts of withholding and withdrawing care and discover how these are resolved in medical ethics. Then, test your understanding with a brief quiz.

Medical Ethics

Ethical decisions can be hard to make in any walk of life. However, when those decisions directly impact people's lives and well being, they're especially important. In the world of medical ethics, or the morality of healthcare, one of the biggest questions professionals face is deciding when to not treat a patient. This can happen in one of two ways. Withdrawing care means stopping a treatment. Withholding care is never starting a treatment, and there can be many reasons for both of these. However, in the end, the only reasons that matter are those agreed upon by physician and patient. So, unlike many questions of ethics, this one isn't about individual choice. It's all about teamwork.

Withholding vs. Withdrawing Care

Just to recap, withholding care means that a physician never begins a treatment. For example, if a patient with cancer and their doctor decide that chemotherapy is not the best option, they could choose to withhold that treatment. Patients opt to withhold care for many reasons. Perhaps they fear that the treatment will be worse than the actual medical condition. Sometimes patients with a terminal illness decide they would rather manage their pain and try to enjoy the remainder of their lives, rather than fighting against impossible odds and possibly increasing their suffering. And, where's the physician in this? Making sure that the patient is fully informed about the benefits and risks of every possible procedure, so that the patient can make an informed decision about their healthcare.

On the other hand, withdrawing care is stopping a treatment. Say that a patient is on an experimental drug that isn't working; they will likely stop using that medicine. People can choose to withdraw care if a treatment isn't working, and again, this often becomes an issue with terminally ill patients. The choice to withdraw care can be a powerful moment for people who have accepted their conditions and are finding peace with their own mortality.

Note that ethically, and legally, there is no distinction between withholding and withdrawing care. One is not more moral than the other. The morality, and legality, of both is completely determined by how they are handled between physician and patient.

Autonomy and Surrogate Decision Making

So, how do we make sure that both withholding and withdrawing medical care are done ethically? By respecting the patient's autonomy, or their ability to make rational decisions for themselves. When we say that someone is autonomous, we recognize that they are a rational individual, and we must treat them accordingly. That's the basis for medical ethics here; the physician must always respect the autonomy of the patient. That means fully discussing every medical option with the patient. Just because the physician thinks that a treatment may be the best solution, whether or not to use it is ultimately the patient's decision. Lying or omitting information about risks or side effects to encourage the patient to accept a treatment would be immoral, even if that treatment could save their life. At the end of the day, it's up to the patient whether a specific treatment should be withheld or withdrawn. The ethical duty of the physician is just to make sure that the patient is well enough informed to make that decision.

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