Negotiating end-of-life issues

Intensive care physicians regularly face dying patients. Negotiating end-of -life decisions has become a relatively common procedure in the high-techno logic environment of the ICU with its life-prolonging therapies. An underst anding of the psychophysiologic process of dying, goals of treatment, and t he professional caregivers' responsibility is necessary to ensure that the dying process is humane, caring, compassionate, and respectful of the value s of the patient and family. The empathetic physician must exhibit humility and vulnerability. Negotiating end-of-life decisions also requires an unde rstanding of the ethical principles that provide crucial anchor points from which sound clinical reasoning can proceed. This negotiation applies parti cularly when limiting or stopping life-sustaining treatment is proposed. Is sues relevant to the infant and child at the end of life are also addressed .