High-stakes examinations enjoy widespread use as summative assessments in higher education. We review the arguments for and against their use, across seven common themes: memory recall and knowledge retention; student motivation and learning; authenticity and real-world relevance; validity and reliability; academic misconduct and contract cheating; stress, anxiety and wellbeing; and fairness and equity. For each theme, we evaluate empirical evidence for the perceived pedagogical benefits and pedagogical drawbacks of high-stakes examinations. We find that relatively few of the perceived academic benefits of high-stakes examinations have a strong evidence base. Support for their use is largely rooted in opinion and pragmatism, rather than being justified by scientific evidence or pedagogical merit. By contrast, there is substantial evidence for pedagogical drawbacks of high-stakes summative examinations. We conclude that the current heavy reliance on high-stakes final examinations in many university subjects is poorly justified by the balance of empirical evidence.