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Updated: May 6, 2026

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Withdrawing and withholding life-sustaining treatment.

Thomas I Cochrane1

  • 1Department of Neurology and Center for Bioethics, Brigham and Women's Hospital, Boston, MA, USA.

Handbook of Clinical Neurology
|November 5, 2013
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Summary

This review examines the ethics of withholding or withdrawing life-sustaining treatments, focusing on decision-making complexities and prognostic uncertainty in critical care settings.

Keywords:
competence and capacitydecision-makingend-of-lifelife-sustaining treatmentwithholding and withdrawing

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Area of Science:

  • Medical Ethics
  • Bioethics
  • Critical Care Medicine

Background:

  • Ethical considerations surrounding life-sustaining therapies are complex.
  • Distinctions between withholding and withdrawing treatment lack clear moral differentiation.
  • Prognostic uncertainty complicates end-of-life care decisions.

Purpose of the Study:

  • To review the ethics of withholding or withdrawing life-sustaining therapies.
  • To analyze the ethical and moral distinctions between withholding and withdrawing treatment.
  • To provide guidance on the decision-making process for forgoing life-sustaining therapy.

Main Methods:

  • Literature review of ethical principles.
  • Analysis of decision-making processes in critical care.
  • Review of recent literature specific to neurologic intensive care units.

Main Results:

  • Ethical principles guide decisions to forgo life-sustaining therapy.
  • Prognostic uncertainty presents significant challenges.
  • Clear guidance for decision-making is provided.

Conclusions:

  • Ethical decision-making regarding life-sustaining therapies requires careful consideration of principles and uncertainties.
  • The distinction between withholding and withdrawing treatment is ethically ambiguous.
  • Guidance is offered for navigating these complex decisions, particularly in neurologic intensive care.