End-of-life (EOL) care in the neurocritical care unit (neuro ICU) is fraught with ethical, medical, and logistical challenges. Prognostic uncertainty, family dynamics, cultural and religious considerations, and resource limitations add layers of complexity to EOL decision-making. This chapter explores the key controversies in EOL care, including the timing and accuracy of prognostic assessments, the role of advance directives, the influence of surrogate decision-making, and the ethical principle of medical futility. It also addresses challenges in implementing do-not-resuscitate (DNR) orders, managing conflicts between family wishes and medical recommendations, and integrating palliative care in neurocritical settings. Controversial topics such as sedation and analgesia use, artificial nutrition and hydration, and the ethical dilemmas of withdrawing life support are analyzed. The chapter emphasizes the need for effective communication strategies and multidisciplinary collaboration to align treatment goals with patient and family values. By understanding and addressing these controversies, healthcare professionals can navigate the complexities of EOL care with compassion and sensitivity, ultimately enhancing patient-centered outcomes in the neuro ICU.