End of life in the Intensive Care Unit

A bio-social revolution has been prompted by the capacity of artificial organ support technology to effectively sustain and/or replace many of the functions of vital organs. The consequent possibility of manipulating the dying process has generated many problems, which range from the necessity of rationing scarce and expensive resources to the definition of optimal care for dying people and the necessity of redefining death itself. In all of these situations, facts and values are strictly interconnected, and actions should be accompanied by careful bioethical reflection. In this text, we will briefly explore these issues in an attempt to illustrate the main problems related to the management of end-of-life care in the intensive care environment. We also present the protocol we use to make and implement difficult end-of-life decisions in our intensive care unit.