CHEST Guidelines-Response_chest

Response_chest_30

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Jeffrey P. Bishop and Jason T. Eberl respond to a critique from Yip et al regarding their article on the ethical implications of withdrawing life-sustaining treatment (LST) under crisis standards of care. Yip et al focused on the rule of double effect (RDE), particularly the condition that the negative outcome of an action should not be the means to achieve a good outcome. They argue that the death of the first patient, while not directly caused, effectively becomes a means to ensure another patient’s survival.<br /><br />Bishop and Eberl counter this interpretation by discussing the nuances of intention in RDE. They clarify that an outcome that is foreseen is not necessarily directly intended. For instance, withdrawing LST from a patient might foreseeably lead to their death, but the intention is not the death itself, but rather the availability of resources for another patient. They use a military analogy to further elaborate on this point: a general may withdraw troops from one city to defend another without intending for the first city’s inhabitants to die, as those deaths aren't a means to achieve the defense of the second city.<br /><br />Bishop and Eberl assert that their approach is consistent with nonutilitarian ethical frameworks, referencing thinkers such as Augustine and Thomas Aquinas, and emphasize the role of medical practitioners in making decisions that benefit the collective well-being during crises. They distinguish their approach from strict utilitarianism, aligning more with a broader ethical perspective that seeks the greater societal good while acknowledging individual losses. Their response aims to clarify the ethical justification for the unilateral withdrawal of LST based not solely on utilitarian reasoning but on a balanced ethical standpoint.

Keywords

ethical implications

life-sustaining treatment

crisis standards of care

rule of double effect

intention

nonutilitarian ethics

Augustine

Thomas Aquinas

medical ethics

resource allocation