Withholding vs withdrawing treatment
What it means
Ethically and legally, WITHHOLDING a treatment and WITHDRAWING one already started are equivalent — neither is killing if the treatment is no longer in the patient's best interests (or is validly refused). Withdrawing a futile/unwanted treatment that then leads to death is allowing the disease to take its course, distinct from an act intended to cause death.
Worked example
Stopping non-beneficial ventilation in a dying patient (withdrawing) is ethically the same as not starting it (withholding) and is not euthanasia.
In the exam
A team debates whether stopping a treatment already started is different from never having begun it in a dying patient.
What settles it
Withholding and withdrawing are morally/legally EQUIVALENT; both differ from an ACT intended to cause death (which is unlawful).
Classically confused with
Doctrine of double effect
Source: GMC end-of-life; case law