Author Affiliations: Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia (Dr Rocker); University of Washington School of Medicine, Harborview Medical Center, Seattle (Dr Curtis).
Despite many scientific advances in critical care medicine and the continued
best efforts of intensivists, the intensive care unit (ICU) remains a setting
where, unfortunately, many patients will die. Among patients with chronic
disease who die in the hospital, approximately half are cared for in an ICU
within 3 days of their death and one third spend at least 10 days in the ICU
during their final hospitalization.1 In 1995,
approximately 20% of deaths in the United States occurred in an ICU.2 Many studies in the United States, Canada, and Europe
consistently have shown that the majority of ICU deaths involve withholding
or withdrawing life-sustaining treatments.3- 10 Intensive
care therefore involves difficult decisions about the use of life-sustaining
treatments for critically ill patients who do not respond to critical care
therapies. For these patients, an important goal is to achieve the best possible
death and the most compassionate care possible for their families.
Graeme M. Rocker, J. Randall Curtis. Caring for the Dying in the Intensive Care UnitIn Search of Clarity. JAMA. 2003;290(6):820–822. doi:10.1001/jama.290.6.820