Many terms may arise in end-of-life care discussions, such as ‘euthanasia,’ ‘assisted suicide,’ ‘withholding treatment,’ ‘withdrawing treatment,’ and ‘palliative sedation.’ They are often misunderstood and sometimes confused. Understanding these terms can assist in decision-making and ensuring quality of life.

A relatively recent literature review by Boivin and colleagues (2015) developed a descriptive classification of medical end-of-life practices, regrouping them into three distinct categories.

First, there are interventions where medical treatments that can potentially prolong life are withdrawn or withheld. Decisions to withdraw and withhold medical treatments frequently occur within the context of palliative medicine.

  • Withholding treatment refers to the decision not to start or increase a treatment beyond a critical threshold following in accordance with the wishes of the patient. Perhaps the most frequent example is the do not resuscitate (DNR) order (or DNAR – do not attempt to restore). Withholding resuscitation efforts will almost inevitably result in death from a cardiac arrest should one occur.

  • Withdrawing treatment is the removal of a life-sustaining intervention that has become futile and only prolongs the dying process, following expressed wishes of the patient or surrogate.

Second, there are interventions where certain drugs are administered to help with symptom management, even if an unintended side effect may shorten the life.

  • Palliative sedation is considered a last resort when usual treatment cannot relieve symptoms at the end of life. Palliative sedation constitutes administering drugs to palliate a patient’s pain, sometimes to the point of unconsciousness (continuous palliative sedation). The explicit aim of palliative sedation is to reduce awareness of distressing symptoms at the end of life. It is considered part of a standard medical procedure: it does not constitute termination of life because the drugs administered are not the cause of death.

  • Pain management refers to the administering of pain medications and other palliative therapies. The intent explicitly concerns the relief of symptoms, even if the possibility exists that such treatments could hasten death.

And third, there are interventions involving a doctor’s use of a lethal drug not justified by a specific effect on symptom management or treatment of a medical condition.

  • Euthanasia corresponds to administering a fatal dose of a suitable drug, usually by a physician, to the patient on their express request and intends to relieve unbearable pain and suffering by accelerating death.

  • Assisted Suicide Assisted suicide is the act of a physician prescribing a lethal dose of medication that the patient takes himself to cause death. The fundamental difference between euthanasia and assisted suicide is that the patient takes the drug himself. In both cases, the physician must ensure that the statutory due care criteria are fulfilled.


  1. Boivin A, Marcoux I, Garnon G, et al. Comparing end-of-life practices in different policy contexts: a scoping review. Journal of Health Services Research & Policy. 2015;20(2):115-123. doi:10.1177/1355819614567743
  2. Downie J, Gupta M, Cavalli S, Blouin S. Assistance in dying: A comparative look at legal definitions. Death Stud. 2022;46(7):1547-1556. doi: 10.1080/07481187.2021.1926631. Epub 2021 May 28. PMID: 34048332.
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  6. Vincent, J. L. (2005). Withdrawing may be preferable to withholding. Critical Care, 9(3), 1-4.