Are withholding and withdrawing therapy always morally equivalent?

D. P. Sulmasy, J. Sugarman, J. Harris

Research output: Contribution to journalArticlepeer-review


Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored.

Original languageEnglish (US)
Pages (from-to)218-224
Number of pages7
JournalJournal of medical ethics
Issue number4
StatePublished - 1994
Externally publishedYes


  • Allowing to die
  • Ethics
  • Justice
  • Medical ethics
  • Resource allocation
  • Withholding treatment

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Arts and Humanities (miscellaneous)
  • Health Policy


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