End-of-Life Decision Making and Care of the Dying Patient

Every two weeks, the American College of Chest Physicians issues a PCCSU (Pulmonary Critical Care Sleep Update).  Each one features timely, concise, diagnostic information on current pulmonary, critical care, and sleep medicine issues.  The second PCCSU in June 2011 is by Yale University Medical Critical Care Director Mark Siegel.  It is titled “End-of-Life Decision Making and Care of the Dying Patient."

The objective of his brief review is to highlight effective approaches to end-of-life decision making and palliative care in the ICU.  Here are his objectives:

• Explore the key ethical principles that underlie sound end-of-life decision making.


• Consider the key structural components necessary to implement effective triage policies.


• Discuss futility as a rationale for unilateral decisions to forgo life-sustaining therapy.


• Address common sources of conflict between ICU physicians and patients’ family members.


• Highlight key features of effective palliative care in the ICU setting.