End-of-Life in the ICU

  • J. -L. Vincent


The intensive care unit (ICU) is generally considered as part of the hospital where patients are treated during an acute severe illness or after acute major injury. However, the ICU is also a common place of death with 1 in 5 Americans dying during or just after an ICU admission [1]. Advances in modern medicine have altered the dying process such that many deaths in hospital, and particularly in the ICU [2, 3, 4, 5], are preceded by an end-of-life decision, a decision to withdraw or withhold life-supporting therapy. There is no specific definition of “end-of-life,” but it is generally considered to be the period during which it is recognized that a patient has a terminal process and that further treatment will offer no benefit, and to be the transition period from cure to comfort [6]. The decisions surrounding end-of-life on the ICU are often complex because they are affected not only by medical factors, but also by multiple personal aspects, including individual preferences, religion, and cultural influences. The influence of family and friends in such decisions can also be considerable. Some recommendations for end-of-life care have been published in the USA [7] and by several national medical societies, but there remains considerable variability in the approach to end-of-life care and decision making at an international, national, and even local level.


Intensive Care Unit Distributive Justice Ethic Consultation Acute Severe Illness Intensive Care Unit Trial 


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Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • J. -L. Vincent
    • 1
  1. 1.Department of Intensive Care, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium

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