In emergency medicine, a significant difference rightfully persists be
tween the withholding and withdrawal of life-sustaining medical treatm
ent. The justification for this difference stems in part from the natu
re of emergency medical practice and the unique manner in which clinic
ians apply many ethical principles. In the usual setting, the decision
to withhold further medical treatment is done quietly, often without
input from the patient or surrogate decisionmaker, whereas withdrawal
of ongoing medical treatment can be more obvious and difficult. This s
ituation is reversed in the emergency medicine setting. The withholdin
g of emergency medical treatment is much more problematic than later w
ithdrawal of unwanted or useless interventions. Emergency physicians a
nd prehospital providers often lack vital information about their pati
ents' identities, medical conditions, and wishes. Society also has spe
cific expectations of emergency physicians. Because of the nature of e
mergency medicine, both in the prehospital and the emergency departmen
t settings, the distinction between withdrawal and withholding of medi
cal treatment has never disappeared and is not likely to do so in the
future.