Virtue Theory and the Lawfulness of Withholding or Withdrawing Treatment or Care

Virtue theory as best understood both excludes some intentional actions and intentional omissions as inherently incompatible with the goods of worthwhile human practices and seeks the mean between excess and defect. The Hippocratic tradition excludes withdrawal of treatment with intent to end life. The virtuous physician will then seek a mean between overtreatment and undertreatment. This requires not only clinical judgment (techne) but an overall best interest decision (phronesis). Medical law has means to prevent undertreatment due to negligence but is less well-adapted to preventing overtreatment. The Law Lords in the Bland case seemingly approved the withdrawal of tube-feeding even with intent to end life, which would mark a radical departure from Hippocratic virtue ethics. Subsequent legal developments have restored consistency to the law by prohibiting omissions with that intent, but they have not remedied the error of condoning undertreatment through neglect of the objective goods of health and life.