Withholding and withdrawing treatment, once again

Consider one more pair of cases to challenge the standard view that there is no significant moral difference between withholding and withdrawing treatment.

A patient’s knee became inflexible with age. The only treatment available is an artificial replacement. The patient is competent, informed, free, but eccentric. Consider two cases:

1. The patient doesn’t agree to an artificial replacement, because the patient thinks that if their leg is flexible, they will be expected to do half of the chores in their two-person household, whereas right now they are getting away with doing only a quarter on account of their bad knee.

2. The patient has already received an artificial replacement, but is dismayed by the fact that they are now expected to do half of the chores, so they demand that a physician inject epoxy into the artificial knee to restore the inflexibility they enjoyed prior to the replacement.

In case 1, it is clear that it is a violation of the patient’s bodily integrity and autonomy to force the knee replacement on them, even if one thinks that the patient’s reason for refusal is terrible.

But in case 2, it would be reasonable for a physician to refuse to inject the epoxy, as this would violate the do-no-harm principle which forbids performing medical procedures, even ones requested by the patient, that on balance harm the patient.

Refraining from implanting an artificial knee is an instance of withholding medical treatment. Refraining from injecting epoxy into the artificial knee is an instance of withdrawing medical treatment by disabling a medical device. It’s a different way of disabling than just by throwing a switch, but it is the least damaging way to disable the artificial knee (removing the artificial knee would be tantamount to amputating the leg above the knee).

The judgment that in case 1, acceding to the patient’s refusal is clearly right, while in case 2, refusing the patient’s request for discontinuation of the artificial knee treatment for joint inflexibility at the very least can be right. Hence withholding and withdrawing are not morally equivalent.