End-of-life care on the intensive care unit: an overview for hospital medical practitioners

Modern intensive care fulfils advanced supportive roles for patients with actual or threatened multiple organ dysfunction. Whilst such roles prolong patients' lives and in the last two decades have reduced intensive care mortality rates, death following intensive care admission remains relatively common. Dealing with death and caring for dying patients is therefore a day-to-day reality of intensive care medicine and an urgent treatment. Clinicians have a duty to recognize the progression towards death and understand the ethical and legal concepts guiding best practice. This includes understanding the concept of medical futility, the ethical and medico-legal framework of decision making in such circumstances and what factors constitute a good death on a case by case basis. This approach can enable the provision of effective end-of-life care for the patient (physical and holistic) and effective guidance for the family.