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Withholding or withdrawing life support versus physician-assisted death

a distinction with a difference?

McClelland, Williama; Goligher, Ewan C.a,b,c

Current Opinion in Anesthesiology: April 2019 - Volume 32 - Issue 2 - p 184–189
doi: 10.1097/ACO.0000000000000686
ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle

Purpose of review Withholding or withdrawing life-sustaining therapy is generally differentiated from physician-assisted suicide or euthanasia based on the distinction between intention and foresight. We reviewed the literature surrounding the validity of this distinction.

Recent findings Many physicians from different specialties express a perceived distinction between intention and foresight. The distinction between intention and foresight differs from the morally irrelevant distinction between doing and allowing. Intention and foresight may be distinguished by their opposing directions of fit between world and mind. Intention is held to be of greater moral significance than foresight because it guides and constrains our actions, determines the moral quality of our actions, and expresses the moral character of the agent. Opponents of the distinction argue that it undermines moral accountability for foreseen consequences of our actions and is overly concerned with the physician's state of mind rather than the patient's experience. They also argue that intentions may be vague and difficult to express or ascertain.

Summary Several reasons may be given in favor of the distinction between intention and foresight. Given this distinction, the moral permissibility of withholding or withdrawing life-sustaining therapy does not necessarily entail the moral permissibility of physician-assisted suicide or euthanasia.

aDepartment of Medicine, Division of Respirology, University Health Network

bInterdepartmental Division of Critical Care Medicine, University of Toronto

cToronto General Hospital Research Institute, Toronto, Canada

Correspondence to Ewan C. Goligher, MD, PhD, Toronto General Hospital, 585 University Ave., Peter Munk Building, 11-192, Toronto, ON M5G 2N2, Canada. Tel: +1 416 340 4800 ext. 6810; e-mail:

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