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Limiting life-sustaining treatment: withholding and withdrawing

  • Topic

Matching treatment to what really helps the patient: not starting, or stopping, measures that no longer benefit them.

Updated

What it is

Limiting (or adjusting) therapeutic effort is the decision not to start, or to withdraw, a life-sustaining treatment such as mechanical ventilation, dialysis or artificial nutrition, when it no longer offers a proportionate benefit or when the patient refuses it. It is not abandoning the patient: the goal shifts from prolonging life at any cost to comfort, and palliative care continues. Clinical ethics treats withholding and withdrawing as equivalent: if a measure can be stopped when it does not help, it can be tried with less fear.

Key facts

  • Proportionality: a measure is disproportionate when its burdens clearly outweigh its benefits for that patient, by their own values.
  • Any measure can be limited: resuscitation, ventilation, vasopressors, dialysis, antibiotics, transfusions, artificial nutrition and hydration.
  • Time-limited trial: a measure is started with an agreed goal and time frame, and withdrawn if the goal is not met.
  • The World Medical Association states that a doctor who respects a refusal of treatment does not act unethically, even if the patient dies.
  • Resolution 813 of 2026, art. 17: throughout AET, symptom relief with a palliative care approach and support for the family are guaranteed.

Step by step

  1. Confirm the diagnosis, prognosis and real options with the team; ask for a second opinion if in doubt.
  2. Find out the patient's values: what they say today, their DVA, or what their representatives know of them.
  3. Propose the plan in a meeting with the patient or family, in plain language and without rushing.
  4. Agree which measures will not be started and which will be withdrawn, and how symptoms will be controlled.
  5. Record the decision, its reasons and who took part in the medical record.
  6. Review the plan if the clinical situation or the patient's wishes change.

In clinical practice

  • Withdrawing ventilation from a patient with a neurological injury with no possible recovery is a clinical and ethical decision, not homicide, when done for the right reasons and with due agreement.
  • Before support is withdrawn, control of breathlessness and distress is planned so the patient does not suffer.
  • If the family asks to «do everything», explore what they fear and hope for; often «everything» means «do not abandon them».
  • Persistent disagreements go to the hospital ethics committee before acting.
  • Law 1733 of 2014, art. 1: recognises the right of people with terminal, chronic, degenerative and irreversible disease to forgo unnecessary medical treatment voluntarily and in advance.
  • Law 1733 of 2014, art. 5: the patient has the right to clear information, a second opinion and to take part in decisions; if the adult is unconscious, relatives decide in the order the law sets.
  • Resolution 813 of 2026, arts. 14 to 20: adjusting therapeutic effort (AET) aims to prevent therapeutic obstinacy and includes refusal of life-support measures; the record must state what is withdrawn, what continues for a set time, what continues indefinitely and what is not started (art. 17); the hospital ethics committee gives an advisory opinion within at most 15 calendar days (art. 20).
  • The Documento de Voluntad Anticipada (Resolution 2665 of 2018) lets a person put in writing their refusal of future measures.

Test yourself

Think of the answer, then tap the question to see it.

Is withdrawing a treatment ethically worse than not starting it?

No. Clinical ethics treats them as equivalent; what matters is whether the measure gives a proportionate benefit and whether the patient wants it.

What is a time-limited trial?

Starting a measure with an agreed goal and time frame, and withdrawing it if the goal is not reached by the end of that time.

Which Colombian law recognises the right to forgo unnecessary medical treatment?

Law 1733 of 2014, in its article 1.

Is respecting a capable patient's refusal of ventilation euthanasia?

No. It respects their autonomy; death is due to the underlying disease, not to an act intended to cause it.

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Connections

← All of medical ethics

Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: WMA Declaration of Venice on End of Life Medical Care (World Medical Association, 2022); WMA Declaration on Euthanasia and Physician-Assisted Suicide (World Medical Association, 2019); Ley 1733 de 2014 (Ley Consuelo Devis Saavedra) (Función Pública, Gestor Normativo, 2014); Boletín Jurídico No. 04 de 2026, section 2.2.6: Resolución 813 de 2026 (Ministerio de Salud y Protección Social, 2026).

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