Intensive Care Medicine has just published an interesting short article, in which Drs. Jeffrey D. Edwards (Columbia University), Louis P. Voigt and Judith E. Nelson (Memorial Sloan Kattering Cancer Center, New York) summarize ten key points on the provision of palliative care in the intensive care unit (ICU). They argue that, to ensure the best care in the ICU, palliative care has to be part of the clinical practice.
1. “Palliative care is relevant for all critically ill patients”
The holistic approach of palliative care is not only aimed to improve the quality of life of patients with a life-limiting condition, but can also help patients who are critically ill, and who may or may not be likely to survive.
2. “Palliative care is the responsibility of all clinicians in the ICU”
Palliative care as a medical specialty or sub-specialty is available in some countries, and a growing number of physicians are training in it where possible. However, a “primary/generalist” knowledge of palliative care should be the responsibility of all ICU clinicians. The authors recommend a “mixed model”, in which “primary palliative care” (i.e. general palliative care knowledge by ICU clinicians) is combined with the input of specialists in palliative care.
3. “ICU clinicians can and are obliged to ensure patient comfort at the end of life”
Many deaths in the ICU are due to a limitation in life support. Therefore, critical care specialists must be aware of the ethical implications of withholding and withdrawing interventions, as well as of the pharmacological and non-pharmacological treatments to prevent, as much as possible, suffering at the end of life.
4. “A decision to allow a natural death does not by itself mean that comfort is the patient’s exclusive goal or that intensive care interventions should be withheld/withdrawn”
It is important to have “clear, sensitive, and nuanced discussion