Approach to Difficult Decisions and End-of-Life Care

Abstract

Invasive organ support does not always result in a meaningful recovery, and many deaths in Intensive Care Units are preceded by a decision to withhold or withdraw life-sustaining therapy. We will discuss the principles underpinning decisions to withhold or withdraw life-sustaining therapy, including for those patients who lack the capacity to be involved in decisions about their care.

Symptoms such as pain, nausea, dyspnoea, distress and anxiety are common in critical illness and at the end of life, and assessing and managing these is essential when withdrawing invasive organ support.

Organ donation is an important aspect of end-of-life care in the Intensive Care Unit. It can occur after a ventilated patient has been declared dead when brainstem testing has confirmed irreversible loss of brainstem function (donation after brain death), or after death has been confirmed by circulatory criteria following planned withdrawal of life-sustaining therapy (donation after circulatory death).