Intending to avoid the treatment burdens only: the doctrine of double effect and withholding or withdrawing life-sustaining treatment.

Abstract

It is often believed that withholding or withdrawing life-sustaining treatment is justifiable only when the patient's death is not intended. Also, in accordance with this belief, many argue that the justification of withholding/withdrawing life-sustaining treatment is an application of the doctrine of double effect (hereafter DDE). This paper aims to defend these accounts from some important criticisms. Baruch Brody maintains that most people intend the patient's death when they withhold/withdraw such treatments and that therefore, there are many cases of withholding/withdrawing treatment that are clearly justifiable but rendered unjustifiable by the accounts. Daniel P. Sulmasy asserts that withholding/withdrawing treatment rarely satisfies DDE's fourth condition (that the good effect of the act is proportionately greater than its bad effect) because the goodness of avoiding treatment burden seldom compares to the badness of shortening life. I examine these claims and show that they are mistaken. Central to the discussion in this paper is the idea that those who withhold/withdraw life-sustaining treatment often only intend to avoid the burdens posed by the treatment itself and not to shorten the patient's life. It will be argued that both Brody and Sulmasy are led to an erroneous conclusion because they fail to have an accurate understanding of this idea and its implications.