End-of-Life Choices and Ethical Responsibility: Clinical Perspectives on Letting Die and Euthanasia

End-of-life decision-making presents one of the most profound ethical challenges in clinical medicine. Central to this debate is the moral distinction between letting die—withholding or withdrawing life-sustaining treatment—and euthanasia, the intentional act of ending life to relieve suffering. This paper critically examines how core bioethical principles guide physicians in navigating this boundary within doctor–patient decision-making. Using a normative literature review supported by qualitative content analysis and hermeneutic interpretation, the study analyzes key scholarly and professional sources drawn from major academic databases. The analysis reveals that ethically defensible practices of letting die are grounded in respect for patient autonomy, proportionality of treatment, beneficence, and non-maleficence, where death results from the underlying illness rather than deliberate clinical action. By contrast, euthanasia remains ethically contested because it introduces intentional life termination, raising profound questions about moral agency, professional responsibility, and the identity of medicine as a healing profession. Ethical frameworks—including principlism, the <i>Doctrine</i><i> </i><i>of</i><i> </i><i>Double</i><i> </i><i>Effect,</i> and theories of <i>Prima</i><i> </i><i>Facie</i><i> </i><i>Duties</i>—provide clinicians with structured reasoning to distinguish permissible omissions from morally contentious interventions. The study argues that ethically responsible end-of-life care depends not only on abstract principles but also on transparent communication, shared decision-making, and advance care planning. By integrating philosophical analysis with clinical ethics, the paper clarifies the moral foundations that sustain compassionate, patient-centered, and professionally accountable end-of-life practice.