Withholding and Withdrawing Life-Sustaining Treatment

  • Ralf J. JoxEmail author


Population-based studies have demonstrated that a significant and increasing proportion of deaths is preceded by a decision to withhold or withdraw life-sustaining treatment, defined as a treatment without which life would, with a very high probability, end within a foreseeable period. This chapter discusses ethical considerations around withholding and withdrawing life-sustaining treatments with a focus on neurologic disease. I discuss epidemiology, definitions and terminology, the ethical criteria for guiding decision-making and present a goals of care-based algorithm that may help make clinical decisions near the end of life. This algorithms suggests that treatment should not be administered unless it is both medically appropriate (indicated) and supported by the patient’s autonomous will. If patients or proxies demand a treatment considered medically inappropriate, the ethically correct response depends on the analysis of the underlying reasons of conflict. The chapter ends with some practical suggestions concerning advance care planning, palliative care consultation and clinical ethics consultation.


Withholding treatment Terminal care Life support care Palliative care Ethics consultation 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilian University MunichMunichGermany
  2. 2.Geriatric Palliative CareLausanne University HospitalLausanneSwitzerland

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