Withdrawing and withholding treatment in intensive care. Part 3. Practical aspects.

A major goal of intensive care units should be to provide an environment in which death may occur with dignity if cure is impossible. The key issues in providing such an environment are the establishment of consensus that cure is impossible, and the provision of a resource person who has been a major participant in efforts to cure the patient. This person leads discussion with the patient or relatives, seeking concurrence rather than permission when the withdrawing or withholding of care is under consideration. We present problems which may arise in facilitating a dignified demise, and a practical approach to these problems.