Statement of the 5th International Consensus Conference in Critical Care Challenges in end-of-life care in the ICU☆Brussels, Belgium, April 2003

Abstract

Death, previously a private, usually spiritual or religious event involving family and friends is today by contrast, often public and technological. The severity of illness of hospitalised patients has progressively increased over recent decades, whilst sophisticated technological support has allowed such patients to survive longer. At the same time it is increasingly accepted that continued aggressive care might not always be beneficial. Death in the ICU, therefore, now frequently follows limitation of life-supporting therapies. As a result, the mission of intensive care has expanded to encompass the provision of the best possible care to dying patients and their families. The International Consensus Conference was convened to discuss some of the challenges posed by these social and medical changes. On 24–25 April 2003, in Brussels, Belgium, a jury of 10 persons, including an anthropologist and nine intensivists, attended the presentations of 30 experts in the field of end-of-life care, and the subsequent discussions, with the objective to answer five specific questions. (1) Is there a problem with end-of-life care in the ICU? (2) What is the epidemiology of death in the ICU? (3) How does one explain the differences between and within countries and cultures regarding end-of-life care? (4) Who decides to limit life-sustaining treatments in the ICU? (5) What is the optimal care for patients dying in the ICU? The following document is a synthesis of the experts’ opinion, the available literature and 2 days of deliberation by the jury.