Intensive Care Medicine

, Volume 30, Issue 5, pp 770–784

Challenges in end-of-life care in the ICU

Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003
  • Jean Carlet
  • Lambertus G. Thijs
  • Massimo Antonelli
  • Joan Cassell
  • Peter Cox
  • Nicholas Hill
  • Charles Hinds
  • Jorge Manuel Pimentel
  • Konrad Reinhart
  • Boyd Taylor Thompson
ESICM Statement

DOI: 10.1007/s00134-004-2241-5

Cite this article as:
Carlet, J., Thijs, L.G., Antonelli, M. et al. Intensive Care Med (2004) 30: 770. doi:10.1007/s00134-004-2241-5

Abstract

The jurors identified numerous problems with end of life in the ICU including variability in practice, inadequate predictive models for death, elusive knowledge of patient preferences, poor communication between staff and surrogates, insufficient or absent training of health-care providers, the use of imprecise and insensitive terminology, and incomplete documentation in the medical records. The jury strongly recommends that research be conducted to improve end-of-life care. The jury advocates a “shared” approach to end-of-life decision-making involving the caregiver team and patient surrogates. Respect for patient autonomy and the intention to honour decisions to decline unwanted treatments should be conveyed to the family. The process is one of negotiation, and the outcome will be determined by the personalities and beliefs of the participants. Ultimately, it is the attending physician’s responsibility, as leader of the health-care team, to decide on the reasonableness of the planned action. In the event of conflict, the ICU team may agree to continue support for a predetermined time. Most conflicts can be resolved. If the conflict persists, however, an ethics consultation may be helpful. Nurses must be involved in the process. The patient must be assured of a pain-free death. The jury of the Consensus Conference subscribes to the moral and legal principles that prohibit administering treatments specifically designed to hasten death. The patient must be given sufficient analgesia to alleviate pain and distress; if such analgesia hastens death, this “double effect” should not detract from the primary aim to ensure comfort.

Keywords

End-of-life care ICU Terminal illness 

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Jean Carlet
    • 1
  • Lambertus G. Thijs
    • 2
  • Massimo Antonelli
    • 3
  • Joan Cassell
    • 4
  • Peter Cox
    • 5
  • Nicholas Hill
    • 6
  • Charles Hinds
    • 7
  • Jorge Manuel Pimentel
    • 8
  • Konrad Reinhart
    • 9
  • Boyd Taylor Thompson
    • 10
  1. 1.Réanimation PolyvalenteFondation Hopital St JosephParis CEDEX 14France
  2. 2.Dwarslaan 16BlaricumThe Netherlands
  3. 3.Department of Anesthesiology/Intensive CareUniv. Cattolica, Policl. GemelliRomeItaly
  4. 4.Washington University School of MedicineSt LouisUSA
  5. 5.Department of Critical Care MedicineHospital for Sick ChildrenTorontoCanada
  6. 6.Pulmonology, Critical Care and Sleep MedicineTufts New England Medical CenterBostonUSA
  7. 7.Department of Intensive CareSt. Bartolomews HospitalLondonUK
  8. 8.Pr. Jose de Anchieta Lote 5, 3º-ACoimbraPortugal
  9. 9.Klinikum für Anästhesiologie und IntensivtherapieKlinikum der Friedrich-Schiller-Universität JenaJenaGermany
  10. 10.Department of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonUSA

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