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August 13, 2003

Caring for the Dying in the Intensive Care Unit: In Search of Clarity

Author Affiliations

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).

JAMA. 2003;290(6):820-822. doi:10.1001/jama.290.6.820

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.