[Integration of principles of palliative medicine into treatment of patients in intensive care units]

Abstract

Intensive care medicine, as well as palliative medicine, is dealing with the limits of life-preserving care. Decision-making in matters of life and death is one of the greatest challenges for physicians, because it may be an area of conflict with regard to aspects of patient autonomy, medical prognosis and the ethics of medical care. At first sight palliative medicine and intensive care medicine seem to be at the opposite ends of care. In palliative medicine, symptom control and alleviation of suffering are the focus of care in order to achieve or maintain the best possible quality of life in patients with incurable, advanced and life-limiting disease. In intensive care medicine, the main focus of care lies on prolongation of life and restoration of health, whenever possible. Approaches, tasks and goals of palliative and intensive care medicine are covering and targeting at different medical situations but are not at opposite ends of care. Shared priorities are pain control and management of other distressing symptoms, alleviation of suffering, comprehensive communication with both, patient and relatives, empathic care that includes the willingness to reflect on end-of-life matters and respect for a human being's dignity. Other common denominators of the team members are: inter-disciplinary teamwork of highly qualified specialists who are able to face and deal with extensive emotional and physical strain, the breaking down of hierarchical structures and team spirit.