Abstract

This paper examines the ethical distinction between letting die and euthanasia within doctor-patient decision-making at the end of life. Its primary objective is to clarify how core bioethical principles guide clinical judgment when lifesustaining treatment is withheld, withdrawn, or intentionally terminated. A systematic literature review was conducted using the PRISMA framework. Data were collected from PubMed, Scopus, and Google Scholar using predefined keywords related to end-of-life ethics, euthanasia, and clinical decision-making. After screening and eligibility assessment, peer-reviewed studies providing explicit ethical analysis were included. The analysis employed qualitative synthesis, integrating normative ethical theory, empirical findings, and professional ethical guidelines. The findings indicate that letting die-through withholding or withdrawing disproportionate or futile treatment-is widely regarded as ethically permissible when grounded in informed consent, proportionality, and respect for patient autonomy. Euthanasia, however, remains ethically contested because it involves intentional life termination and raises concerns regarding professional integrity and the moral identity of medicine. The principles of autonomy, beneficence, non-maleficence, and justice, supported by frameworks such as the Doctrine of Double Effect, provide structured guidance for resolving these tensions. Effective communication and shared decision-making emerge as decisive factors in ethically defensible practice. The paper recommends strengthening ethics education, institutional ethics consultation services, and advance care planning to enhance moral clarity, reduce clinician distress, and ensure alignment between patient values and clinical action.

Keywords: End-of-life ethics, Letting die, Euthanasia, Doctor-patient relationship, Shared decision-making