A diverse group makes compassionate end-of-life decisions in a hospital setting.

End-of-Life Dilemmas in the ICU: How Can We Make Better Decisions?

Beau Callahan in Health & Wellness July 2025 • 4 min read.

"Exploring the knowledge, opinions, and practices of ICU physicians regarding end-of-life decisions to inform better care."

Death and dying are sensitive topics. The process of dying is intertwined with suffering and quality of life. Debates about end-of-life care, such as euthanasia and dysthanasia, require a deep understanding of death itself to set appropriate boundaries for care, both individually and collectively.

Advances in medicine and life-support technologies make it harder to define the limits of treatment in intensive care. Ethical principles like beneficence (doing good) and non-maleficence (doing no harm) can be difficult to uphold. While limiting treatment in hopeless cases can be ethically and morally justifiable, these decisions often lead to bioethical conflicts among healthcare teams and families.

When a family's understanding of a patient's condition differs significantly from the medical team's, creating a suitable treatment plan becomes even harder. Doctors need to communicate their position clearly and be willing to meet again after consulting with other specialists or ethics committees, and explore alternative therapeutic options. But, ultimately, shouldn't the patient have the power to decide about their own dying process, if they are able?

Understanding Physician Perspectives on End-of-Life Care

A diverse group makes compassionate end-of-life decisions in a hospital setting.

A study was conducted in five hospitals in Salvador, Bahia, Brazil, to investigate the knowledge, opinions, and practices of physicians working in Intensive Care Units (ICUs) and semi-ICUs regarding end-of-life decisions. This research aimed to understand how these professionals navigate the complexities of terminal patient care.

The study revealed several key findings:

Comfort over Prolongation: Physicians often prioritize patient comfort, sometimes foregoing life-support measures.
Documentation Concerns: Many physicians admitted to omitting information from medical records due to fears of legal or ethical repercussions.
Need for Clarity: The insecurity stems from a lack of clear information and established legislation on end-of-life matters.
The Patient Voice: While physicians recognize the importance of patient and family involvement, there's a discrepancy between who participates in discussions and who should participate, according to the physicians. They expressed that 77% of doctors consider that patients should participate in decisions.

These findings highlight the ethical and legal challenges surrounding end-of-life care in the ICU. Fear of litigation or ethical sanctions can influence documentation practices, potentially compromising transparency and shared decision-making. The absence of clear guidelines further complicates these sensitive situations.

Moving Forward: Improving End-of-Life Care in the ICU

The study emphasizes the critical need for open and multidisciplinary discussions about end-of-life issues in hospitals. These discussions should involve physicians, patients, families, and other relevant healthcare professionals.

Key actions to improve end-of-life care include:

<ul> <li>Developing clear, ethical guidelines and legal frameworks to support physicians in making difficult decisions.</li> <li>Promoting education and training for healthcare professionals on end-of-life care, communication, and ethical considerations.</li> <li>Empowering patients and families to actively participate in decision-making, ensuring their values and preferences are respected.</li> <li>Fostering a culture of transparency and open communication within healthcare teams and with patients and families.</li> </ul>

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1590/s1413-81232011000700012, Alternate LINK

Title: Dilemas Sobre O Fim-Da-Vida: Informações Sobre A Prática Médica Nas Utis

Subject: Public Health, Environmental and Occupational Health

Journal: Ciência & Saúde Coletiva

Publisher: FapUNIFESP (SciELO)

Authors: Debora Gaudencio, Octavio Messeder

Published: 2011-01-01

Everything You Need To Know

What are the key challenges in making end-of-life decisions within the ICU?

End-of-life decisions in the ICU are complex because they involve balancing patient comfort, ethical principles like beneficence and non-maleficence, and the use of advanced life-support technologies. The absence of clear information and established legislation exacerbates these challenges, leading to bioethical conflicts among healthcare teams and families. Physicians often prioritize patient comfort, even if that means foregoing life-support measures.

How do concerns about documentation affect end-of-life care in the ICU?

Physicians' documentation practices are influenced by their fear of legal or ethical repercussions. Many doctors admit to omitting information from medical records, potentially compromising transparency and shared decision-making. This insecurity stems from a lack of clear information and established legislation on end-of-life matters, which further complicates these sensitive situations, especially in the ICU context.

What role do patients and families play in end-of-life decisions, and how can it be improved?

The study highlights a discrepancy between the involvement of patients and families in end-of-life discussions and the ideal level of participation. While physicians recognize the importance of including both, there is a gap in practice. The physicians expressed that 77% of doctors consider that patients should participate in decisions about their own dying process, underscoring the need for better communication and shared decision-making in the ICU.

What is dysthanasia, and why is it a concern in end-of-life care?

Dysthanasia refers to the practice of prolonging life when there is no hope of recovery or improvement in the patient's condition. This can be ethically challenging, as it may conflict with the patient's wishes and quality of life. Ethical principles like beneficence (doing good) and non-maleficence (doing no harm) need to be carefully considered when dealing with the limitations of treatment in hopeless cases, often leading to bioethical conflicts.

What steps can be taken to improve end-of-life care in the ICU?

To improve end-of-life care, there is a critical need for open and multidisciplinary discussions about end-of-life issues in hospitals. These discussions should involve physicians, patients, families, and other relevant healthcare professionals. Such conversations facilitate shared decision-making, clarify patient wishes, and ensure ethical and legal compliance within the ICU setting.