Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 11 ( 2015 ) > List of Articles


Framework for decision-making and management of end-of-life decisions in Intensive Care Units: A modified protocol

Namrata Maheshwari, Alex Psirides, Amit K. Mandal

Keywords : Checklist, end-of-life decisions, Intensive Care Unit

Citation Information : Maheshwari N, Psirides A, Mandal AK. Framework for decision-making and management of end-of-life decisions in Intensive Care Units: A modified protocol. Indian J Crit Care Med 2015; 19 (11):655-660.

DOI: 10.4103/0972-5229.169339

License: CC BY-ND 3.0

Published Online: 01-02-2013

Copyright Statement:  Copyright © 2015; The Author(s).


End-of-life decisions are being made daily in Intensive Care Units worldwide. The spectrum of options varies from full-continued care, withholding treatment, withdrawing treatment, and active life-ending procedures depending on the institutional practices and legal framework. Considering the complexity of the situation and the legalities involved, it is important to have a structured approach toward these sensitive decisions. It does make sense to have a protocol that ensures proper documentation and helps ease the physicians involved in such decisions. Clear documentation in the format of a checklist would ensure consistency and help the entire medical team to be uniformly informed about the end-of-life plan.

PDF Share
  1. Rothman DJ. Where we die. N Engl J Med 2014;370:2457-60.
  2. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al. Use of intensive care at the end of life in the United States: An epidemiologic study. Crit Care Med 2004;32:638-43.
  3. Ventres W. Educating our patients about life and the end of life: Toward a pedagogy of dying. J Am Board Fam Med 2014;27:713-6.
  4. Romain M, Sprung CL. End-of-life practices in the intensive care unit: The importance of geography, religion, religious affiliation, and culture. Rambam Maimonides Med J 2014;5:e0003.
  5. Psirides AJ, Sturland S. Withdrawal of active treatment in intensive care: What is stopped - Comparison between belief and practice. Crit Care Resusc 2009;11:210-4.
  6. Bloomer MJ, Tiruvoipati R, Tsiripillis M, Botha JA. End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study. Aust Crit Care 2010;23:13-9.
  7. Datta R, Chaturvedi R, Rudra A, Jaideep CN. End of life issues in the intensive care units. Med J Armed Forces India 2013;69:48-53.
  8. Myatra SN, Salins N, Iyer S, Macaden SC, Divatia JV, Muckaden M, et al. End-of-life care policy: An integrated care plan for the dying: A Joint Position Statement of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Association of Palliative Care (IAPC). Indian J Crit Care Med 2014;18:615-35.
  9. Medical Treatment of Terminally Ill Patients (for the Protection of Patients and Medical Practitioners). 196 th Report of Law Commission of India; 2006. Available from: http://www.lawcommissionofindia.nicin/reports/report196.pdf. [Last accessed on 2015 May 05].
  10. Passive Euthanasia - A Relook. 241 st Report of Law Commission of India; 2012. Available from: [Last accessed on 2015 May 28].
  11. Aruna Ramakrishna Shanbaugh vs. The Union of India and Ors. 2011 4 SCC 454 and 524. Writ petition (crl.) no(s). 115 of 2009, date: 07/03/2011 SC. Available from: [Last accessed on 2015 Nov 1].
  12. Carlet J, Thijs LG, Antonelli M, Cassell J, Cox P, Hill N, et al. Challenges in end-of-life care in the ICU. Statement of the 5 th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med 2004;30:770-84.
  13. Psirides A. Allow a Natural Death in Intensive Care - Wellington Intensive Care Unit. AND-ICU form v6.1; October, 2015. Available from: [Last accessed on 2015 Oct 15].
  14. Matsumura Y, Nakada TA, Abe R, Oshima T, Oda S. Serum procalcitonin level and SOFA score at discharge from the intensive care unit predict post-intensive care unit mortality: A prospective study. PLoS One 2014;9:e114007.
  15. Cardona-Morrell M, Hillman K. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL). BMJ Support Palliat Care 2015;5:78-90.
  16. Greer DM, Curiale GG. End-of-life and brain death in acute coma and disorders of consciousness. Semin Neurol 2013;33:157-66.
  17. Australian and New Zealand Intensive Care Society. ANZICS Statement on Care and Decision-Making at the End of Life for the Critically Ill (Edition 1.0). Melbourne: ANZICS; 2014. Available from: [Last accessed on 2015 May 25].
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.