A Note for You
You do not need to read this entire document at once. Please review only the sections that feel relevant to you right now, at your own pace. The ICU staff are here to support you with any questions.
Critical illness is often unpredictable, and the uncertainty regarding recovery can be deeply unsettling. Our aim is to help you prepare if a loved one's prognosis becomes uncertain.
"Patients at the end of their life in the ICU will be treated with the utmost dignity and respect, as if they were expected to recover."
Determining the Next Steps
When a patient’s condition worsens despite intensive support, the focus may shift from curative to palliative care. This ensures comfort and dignity when treatment is no longer beneficial.
The Decision Process
The ICU team monitors vital signs, blood results, and the level of assistance needed. If treatment becomes ineffective, they will discuss transitioning to compassionate care tailored to the patient's needs.
The 'Best Interests' Meeting
For patients unable to communicate, doctors collaborate with family to determine what the patient would have wanted, weighing benefits against potential suffering.
Power of Attorney
A Power of Attorney is a legal designated person authorized to make decisions on a patient's behalf.
- They can refuse specific treatments but cannot demand treatments the medical team deems non-beneficial.
- If no Power of Attorney exists, the senior doctor makes the final decision based on the 'Best Interests' of the patient.
Physical Changes & Comfort Measures
As life-sustaining treatments (like ventilators or blood pressure medications) are withdrawn, the body undergoes natural changes. The focus shifts entirely to comfort management.
Breathing Patterns
Breathing may become irregular or noisy ('death rattle'). This is usually non-distressing for the patient, but medication can be given if it appears uncomfortable.
Skin & Circulation
Hands and feet may feel cool or appear mottled as blood flow changes. Nurses will continue to monitor skin care to ensure comfort.
Pain & Restlessness
The team will administer medications via drips to ensure the patient is pain-free. Agitation is managed by finding a balance between comfort and awareness.
Mouth Care
As hunger and thirst decrease, we focus on oral comfort using wet swabs, lip moisturizers, and ice to prevent dry mouth.
Creating a Peaceful Environment
Staying Connected
Even if unresponsive, hearing your voice can be deeply comforting. You might consider:
- Talking calmly or holding their hand.
- Reading a favorite book or playing soothing music.
- Recording voice messages if you cannot be there in person.
Personal Touches
- • Photos of family & pets
- • Familiar scents (perfume/oils)
- • Religious icons or prayers
- • Personal blankets or pillows
Ongoing Support
If visiting is not possible due to health protocols, designate one person to stay in contact with the ICU team. We are here to help you navigate this time.