Physicians encounter significant difficulty when faced with decisions related to withdrawal of life-sustaining therapy (WLST) in patients with devastating brain injury (DBI). The complexity of this decision-making process is multifactorial, including practitioner- and patient-specific variables, as well as surrogate decision-maker bias, inaccuracies in scoring systems, and inconsistencies in guidelines endorsed by professional societies; these issues all contribute to the significant uncertainty of these situations and variability in treatment paradigm. Solutions are complex; however, analyzing WLST with an urban bioethical lens — which emphasizes the principles of solidarity, agency, and social justice — can enhance physicians’ ability to navigate this uncertainty and ensure that potential solutions are patient-centered. / Urban Bioethics