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

Modern intensive care fulfils advanced supportive roles in the care of patients with actual or threatened multiple organ dysfunction. Such roles prolong patients' lives and whilst intensive care mortality rates have reduced in the last two decades, 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 care for the patient (encompassing both physical and holistic aspects of end-of-life care) and effective guidance for the family.