What is the difference between voluntary and involuntary cessation of care, and how is consent obtained for voluntary cessation?

• A. Voluntary cessation is patient- or surrogate-driven; involuntary is non-consented; consent obtained by signature on a form.
• B. Voluntary cessation is dictated by clinicians; involuntary is patient-driven; consent obtained by signature on a form.
• C. Voluntary cessation is patient- or surrogate-driven; involuntary is non-consented; consent obtained through discussion, documentation, and alignment with patient wishes.
• D. Voluntary cessation requires no consent.

Answer: (C)

The key idea is autonomy in end-of-life decisions: voluntary cessation is driven by the patient or a legally designated surrogate, and the decision to stop care is made with informed discussion and is clearly documented to reflect the patient’s goals. Consent isn’t just a signed form; it comes from open conversations about prognosis, goals of care, and what the patient values, followed by documenting those decisions in the medical record and aligning actions (such as withdrawing non-beneficial treatments or implementing do-not-resuscitate or comfort-focused plans) with those stated wishes. Involuntary cessation, by contrast, occurs when care is stopped without the patient’s or surrogate’s consent or beyond what they would want, which undermines autonomy and ethical practice.