What is the ethical stance on withholding or withdrawing life-sustaining treatment when it aligns with patient wishes or best interests?

• A. Withholding is always unethical.
• B. Both withholding and withdrawing may be ethically permissible when aligned with patient wishes or best interests.
• C. Only withholding is permissible; withdrawing is never.
• D. Only withdrawing is permissible; withholding is never.

Answer: (B)

The question tests whether withholding and withdrawing life-sustaining treatment can be ethically permissible when they reflect what the patient wants or what is in the patient’s best interests. When a patient explicitly wishes not to continue aggressive care, or when a medical plan no longer serves the patient’s goals because it would prolong suffering without proportional benefit, both not starting a treatment and stopping an ongoing one can be ethically justified. The foundation for this view rests on respecting autonomy—honoring the patient’s values and choices—and balancing beneficence and nonmaleficence to avoid prolonging nonbeneficial care or causing unnecessary harm. When the patient cannot decide, decisions should be guided by substitute judgment based on known preferences, values, or advance directives, or by what would be in the patient’s best interests.

Some positions wrongly treat one approach as inherently unethical or claim only one approach is permissible, but ethical analysis supports both actions when aligned with the patient’s wishes or best interests.