Palliative Care In ICU
Regional ICM Teaching

Callum Taylor
callum.taylor4@aapct.scot.nhs.uk

2026-04-22

What This Talk Could Be, But Isn’t

  • Decision making
  • Laws and ethics around treatment cessation
  • DNACPR / TEPs
  • Capacity / POA

What This Talk Is

  • Death In ICU
  • Good vs Good Enough vs Bad Deaths
  • Ways To Affect This
    • Ways We Are Trying Here
  • Current Guidance On This

Numbers Dying In ICU

Publication: ICNARC Case Mix Programme 2023-2034 - n: 190,320

Publication: SICS 2022 - n: 16,616 - 16.7% hospital mortality

Exam Document #1

Ayrshire & Arran: 2025

  • Admissions: 1601
  • Deaths: 245
  • 15.3% unit mortality

Where Do Patients Die?

Ayrshire & Arran 2025 ~13% hospital deaths occur in critical care

How Are They Dying?

  1. Died with ongoing treatment
  2. Withdrawal recognising couldn’t survive admission
  3. Withdrawal recognising couldn’t survive admission in acceptable manner

Exam Document #2

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016. Sprung. JAMA

Good (Enough) Death

Western societies … are bereft of a communally acknowledged model of a good death

McNamara, Good enough death: autonomy and choice in Australian palliative care, 2004, Social Science & Medicine , Vol. 58, No. 5

Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers JAMA. 2000

  1. Relief From Pain and Physical Symptoms
  2. Effective Communication & Relationship with Health-Care Providers
  3. Performance of Cultural, Religious, Spiritual Rituals

  1. Relief From Emotional Distress & Psychological Stress
  2. Autonomy With Treatment-Related Decision-Making
  3. Dying At Preferred Place
  4. Not Prolonging Life Unnecessarily

  1. Awareness of Deep Significance Of What Is Happening
  2. Emotional Support from Family & Friends
  3. Not Being a Burden On Anyone
  4. Right To Terminate One’s Life

Are Critical Care Deaths Bad?

Results

Critical Care vs Hospice

Symptom Burden

Puntillo et al. Symptoms experienced by intensive care unit patients at high risk of dying. 2010. Crit Care Med

Pain

Distress / Delirium

Dyspnoea

Demoule, A., Decavele, M., Antonelli, M. et al. Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement. Intensive Care Med 50, 159–180 (2024)

Bad Death - Family

Complicated Grief ~ Depression ~ PTSD

Increased Risk

  • Younger Person
  • Partner of Relative
  • ICU Consultant Certified < 2009
  • Use of Vasoactives
  • Intubated Whilst Dying
  • Family Disagreements / Difficulty Communicating
  • Family Unprepared For Death
  • Family Not Involved With EOL Decision Making
  • Family Not Having Change To Say Goodbye
  • Family Being Present At Time Of Death

What Are We Doing Locally?

The Person Stuck on High-Flow

  1. Plenty of Deaths in Critical Care
  2. Plenty of Bad Deaths
  3. Plenty of Modifiable Factors For Bad Deaths
  4. Symptom Burden High
  5. Fix Symptom Burden, Fix Bad Death?
  6. Fix Bad Death, Fix Family PTSD?