Intensive care brings together every appropriate treatment to sustain life and help a patient survive a critical illness. Sadly, these treatments are not always enough. In some situations, a decision may be made to withhold or withdraw highly invasive treatment. The priority then becomes ensuring that the patient’s end of life is as peaceful and comfortable as possible.

Many intensive care treatments can cause discomfort or distress. The first aim is therefore to relieve discomfort as fully as possible and prioritise care that provides calm, comfort and dignity. Medicines to relieve pain and anxiety become central. Unpleasant procedures are reviewed and stopped whenever they are no longer beneficial. In some cases, it may also be appropriate to remove as much of the equipment and tubing around the patient as possible.

Throughout the final phase of life, staff will continue to observe the patient’s expressions and reactions, even if they are sedated. Ask any questions that come to mind and share your concerns or observations. This can help the team provide the best possible support to both the patient and those close to them. Tell the team whether you would like to be contacted at any hour of the day or night, or whether you need protected periods of rest.

Being with someone at the end of life—especially when they are unconscious—can be deeply unsettling as well as profoundly sad. Some family members need to begin anticipating practical and administrative arrangements, while others prefer to remain fully in the present and focus on their final time together. Everyone should be able to cope in the way that feels right for them, without judgement or pressure from others. The team is available if you need to talk. You can also ask to meet the unit psychologist, who can support you with overwhelming emotions, difficult thoughts or family tensions.

During end-of-life care, you may wish to observe rituals, invite a representative of your faith or the patient’s faith, speak to the patient, touch or hold them, sit in silence, or sing quietly without disturbing neighbouring rooms. Some people bring a few personal items to make the environment more familiar, such as a scented shawl, photographs or gentle music. Support the patient in the way that feels most meaningful to you. Ask the team if you are unsure what is possible.

Rituals in an intensive care room must never involve a flame or spark—no candles or incense—because medical gases are supplied to the room and there is a genuine risk of fire or explosion.