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Domain 8 : End of life care
Death is inevitably a managed, not a 'natural' process in intensive care. The manner in which it is conducted may affect the survivors - family and staff - for the rest of their lives. Treatment limitation or withdrawal does not mean denial of care; patients should not suffer, and, where possible, their wishes should be determined and respected.


By the end of specialist training, the trainee...

8.1 Manages the process of witholding or withdrawing treatment with the multidisciplinary team
8.2 Discusses end of life care with patients and their families / surrogates
8.3 Manages palliative care of the critically ill patient
8.4 Performs brain-stem death testing
8.5 Manages the physiological support of the organ donor

Features of competent performance

  • Assessment of severity of illness and prognosis
  • Awareness of relevant ethical / legal / religious / cultural issues
  • Effective communication and interpersonal skills - patient / family / staff
  • Effective team-working: promote collaboration, communication & continuity
  • Attempt to minimise distress - patient / family / staff
  • Clear decision making and plan of management
  • Appropriate referral / consultation
  • Recognition of limitations (self and others)
  • Attention to patient safety


All competencies
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Note that the "Resources" that are included in this page, have not been updated in the recent years. An updated collection of useful resources will be available soon as part of the ESICM Academy (for more details, see www.esicm.org).

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