Introduction: Stroke is one of the leading causes of mortality and disability in the world, with clinical manifestations and complications so severe that they negatively affect the patient's recovery, contributing to an uncertain prognosis and difficult decisions with bioethical dilemmas such as artificial nutrition in the context of severe stroke. Presentation of the case: 49-year-old patient with Cerebrovascular Accident in a chronic vegetative state, tracheostomy and gastrostomy user, admitted for infectious complications, in whom, under therapeutic proportionality, the decision is made, shared by medical staff and family, to withdraw artificial nutrition. Conclusions: Difficult decision making involves multiple challenges for both the health personnel and the patient and his or her environment, and must be guided by bioethical principles and proportionality in favor of the quality of life and the benefit of the patient.