Continuous physiological monitoring can retain clinical value near the end of life, yet its informational benefits may diminish or become disproportionate when technological surveillance disturbs rest, reinforces treatment-oriented routines, or conflicts with a patient's priorities for comfort. Decisions to reduce monitoring therefore carry a distinctive nursing-ethical problem: removing or scaling back a technology can be appropriate while withdrawal of nursing attention, symptom observation, communication, or reassurance is not. This philosophical and normative practice paper develops an evidence-informed framework for distinguishing these responsibilities during the last days of life. Recent nursing, palliative-care, critical-care, ethical, and goal-concordant-care scholarship is used to examine three connected questions: what continuous observation is still expected to accomplish; what burdens or relational consequences accompany it; and what responsibilities remain when its technological component is reduced. The analysis identifies proportionality, patient preferences, relational responsibility, epistemic uncertainty, and protection against discriminatory undertreatment as central normative considerations. It proposes that justified monitoring withdrawal should be understood as a reconfiguration of vigilance rather than its disappearance. Technological observation may decrease while bedside assessment, recognition of discomfort, communication, reassurance, documentation, and readiness to respond remain active nursing obligations. The framework is deliberately conditional rather than algorithmic because evidence directly evaluating monitoring withdrawal during the last days of life remains limited. Its purpose is to make the ethical structure of such decisions explicit and empirically testable without converting comfort-focused care into technological neglect.
