Limitation of treatment at the end-of-life: withholding and withdrawal.

Most deaths in the United States occur under the care of a physician. In most of these cases, decisions must be made about whether to initiate and continue or withdraw life-sustaining medical technology, such as cardiopulmonary resuscitation, ventilation, nutrition and hydration, dialysis, transfusions, and antibiotics. All are part of a medical technological armamentarium that should be used when the goal of treatment is a cure. When a cure is not possible or appropriate, these medical technologies should be withdrawn or withheld. The circumstances in which end of life treatment may be ethically and legally limited through withholding or withdrawal are discussed.