End-of-life practices: Ensuring ‘quality of dying’ during withdrawal of life-sustaining measures

The majority of deaths on Dutch intensive care units (ICUs) occur after withdrawal of life-sustaining measures. While curative care centres on survival, end-of-life care focuses on ‘quality of dying’. In end-of-life care, evaluation of all interventions is made in terms of whether they contribute to the patient’s comfort. In general, adequate dosing of opioids and benzodiazepines can provide comfort. Contrary to popular belief, these medications do not hasten death. Pain, dyspnoea-associated distress, anxiety and excessive bronchopulmonary secretion should be routinely assessed, prevented and treated adequately. Withdrawal of lifesustaining measures can consist of withdrawal of mechanical ventilation and/or vasoactive medication; in case of the former, there is no ethical justification for a prolonged weaning process. Family-centred care and communication are essential in endof-life care and continue even after the patient’s death. End-oflife care should be a priority in each ICU to limit suffering and optimise quality of dying.