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Withholding and withdrawing treatment for cost-effectiveness reasons: Are they ethically on par?
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-0987-7653
Linköping University.
2019 (English)In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, no 2, p. 278-286Article in journal (Refereed) Published
Abstract [en]

In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost-effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost-effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019. Vol. 33, no 2, p. 278-286
Keywords [en]
cost effectiveness; equivalence thesis; priority setting; withdrawing; withholding
National Category
Medical Ethics
Identifiers
URN: urn:nbn:se:liu:diva-154575DOI: 10.1111/bioe.12545ISI: 000457454400011PubMedID: 30536795Scopus ID: 2-s2.0-85058386317OAI: oai:DiVA.org:liu-154575DiVA, id: diva2:1290494
Available from: 2019-02-20 Created: 2019-02-20 Last updated: 2019-06-27Bibliographically approved

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Sandman, LarsLiliemark, Jan
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CiteExportLink to record
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Citation style
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  • Other style
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Language
  • de-DE
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  • nn-NB
  • sv-SE
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Output format
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