Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

From Crime Scene Actions in Stranger Rape to Prediction of Rapist Type: Single‐Victim or Serial Rapist?

The differences in crime scene actions in cases of stranger rape committed by convicted offenders were examined between 31 single‐victim rapists and 35 serial rapists. Data were collected from police files, court verdicts, psychiatric evaluations, and criminal records. Findings indicate that the serial rapists were more criminally sophisticated than the single‐victim rapists, during their first and second rapes. The single‐victim rapists were significantly more likely to engage in the interpersonal involvement behavior of kissing the victim, and to engage in pre‐assault alcohol use, than the serial rapists. There was, however, no significant difference in physically violent or sexual behaviors. To investigate the possibility of predicting rapist type, logistic regression analyses were performed. Results indicate that three behaviors in conjunction, kissed victim, controlled victim, and offender drank alcohol before the offense, predicted whether an unknown offender is a single‐victim or serial rapist with a classification accuracy of 80.4%. The findings have implications for the classification of stranger rapists in offender profiling. Copyright © 2012 John Wiley & Sons, Ltd.