[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Medical ethics](https://durgical.com/en/medical-ethics/) › [End of life and donation](https://durgical.com/en/medical-ethics/areas/end-of-life/) › Limiting life-sustaining treatment: withholding and withdrawing

# 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 Nov 5, 2026

## Key points

- Withholding and withdrawing a treatment are ethically equivalent; stopping is not worse than not starting.
- The cause of death is the underlying disease, not the withdrawal of support.
- Respecting a capable patient's refusal is not euthanasia, even if death comes sooner.
- The decision is made with the patient or their representative, explained and recorded in the medical record.
- Limiting effort never means stopping care: symptom control continues.

## 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- Time-limited trial: a measure is started with an agreed goal and time frame, and withdrawn if the goal is not met.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

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- Agree which measures will not be started and which will be withdrawn, and how symptoms will be controlled.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

## Legal framework in Colombia

- 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

## Related 5

- [Medical futility and do-not-resuscitate orders](https://durgical.com/en/medical-ethics/medical-futility-and-do-not-resuscitate-orders/)
- [Killing and letting die: euthanasia, assisted suicide and withdrawal compared](https://durgical.com/en/medical-ethics/killing-and-letting-die-euthanasia-assisted-suicide-and-withdrawal-compared/)
- [Palliative sedation](https://durgical.com/en/medical-ethics/palliative-sedation/)
- [Refusing treatment, including blood transfusion](https://durgical.com/en/medical-ethics/refusing-treatment-including-blood-transfusion/)
- [Advance directives (Documento de Voluntad Anticipada)](https://durgical.com/en/medical-ethics/advance-directives/)

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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](https://www.wma.net/policies-post/wma-declaration-of-venice/) (World Medical Association, 2022); [WMA Declaration on Euthanasia and Physician-Assisted Suicide](https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/) (World Medical Association, 2019); [Ley 1733 de 2014 (Ley Consuelo Devis Saavedra)](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=59379) (Función Pública, Gestor Normativo, 2014); [Boletín Jurídico No. 04 de 2026, section 2.2.6: Resolución 813 de 2026](https://www.minsalud.gov.co/Normatividad_Nuevo/Bolet%C3%ADn%20Jur%C3%ADdico%20No.%2004%20%20de%202026.pdf) (Ministerio de Salud y Protección Social, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/limiting-life-sustaining-treatment-withholding-and-withdrawing/