Intensive Care Medicine

, Volume 46, Issue 1, pp 147–148 | Cite as

Distinction between good palliative care and intending death

  • E. Wesley ElyEmail author
  • Elie Azoulay
  • Charlie L. Sprung

Dear Editor,

We thank JL Vincent, J Creteur and FS Taccone [ 1] for their thoughtful comment on our article [ 2]. There is a key misunderstanding about one term on which the authors did not focus. This is the word “intent.”
  1. 1.

    We do not want anyone in critical care to believe that we are speaking against limitation of life support. When a patient or family judges that any intervention (e.g., tracheostomy) is not justifiable or not in the “best interests” of the patient (i.e., its risks and harms clearly outweigh benefit), then it should either be limited or not performed at all.

  2. 2.

    We wrote that we would “never intentionally shorten the life of a patient.” When practicing good end-of-life care, we are accompanying patients as they die naturally of their diseases and, when patients or families decide against life-sustaining treatment, we are avoiding the artificial prolongation of their dying process. In accepting the natural dying process and shifting to palliative care, we must always...


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical CenterNashvilleUSA

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