Recommendations for end-of-life care in the intensive care unit

Principal Findings:

Family-centered care, which emphasizes

the importance of the social structure within which patients are

embedded, has emerged as a comprehensive ideal for managing


end-of-life care in the ICU. ICU clinicians should be competent in

all aspects of this care, including the practical and ethical aspects


of withdrawing different modalities of life-sustaining treatment


and the use of sedatives, analgesics, and nonpharmacologic


approaches to easing the suffering of the dying process. Several


key ethical concepts play a foundational role in guiding end-of life


care, including the distinctions between withholding and





withdrawing treatments, between actions of killing and allowing
to die, and between consequences that are intended vs. those that
are merely foreseen (the doctrine of double effect). Improved
communication with the family has been shown to improve patient

care and family outcomes. Other knowledge unique to end of-


life care includes principles for notifying families of a patient’s


death and compassionate approaches to discussing options for


organ donation. End-of-life care continues even after the death of


the patient, and ICUs should consider developing comprehensive


bereavement programs to support both families and the needs of


the clinical staff. Finally, a comprehensive agenda for improving


end-of-life care in the ICU has been developed to guide research,


quality improvement efforts, and educational curricula.

Conclusions:
End-of-life care is emerging as a comprehensive
area of expertise in the ICU and demands the same high level of
knowledge and competence as all other areas of ICU practice

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