It has been suggested that today we live in a ‘death denying’ society, even within healthcare settings. There is limited vocabulary for death; it is not a part of life with which people care to engage.¹ With the development of increased scientific knowledge and enhanced technological capability, expectations of the health service are high, especially within the critical care setting. Many patients and their relatives view a successful outcome only as survival from illness or injury, in spite of the immense physical and emotional distress that may be endured by patients and their families during the course of ill health. In contrast, healthcare professionals have been found to be more accepting of death and, during the last days of a patient’s life, wish to see fewer therapeutic interventions.² In part, this can be attributed to repeated exposure to the sadness of end-of-life situations, but is also formulated by notions of what constitutes medical futility and whether or not a patient has currently, or will have in the future, any quality of life. Treatments may be viewed as prolonging the patient’s suffering unnecessarily, whilst death is simultaneously seen as inevitable. However, whilst healthcare professionals must continually make decisions regarding the welfare of others, great care must be taken when making moral judgements about the quality of someone else’s life. Conditions that some people would find unacceptable to live with, others might not.

One of the challenges facing medical and nursing practitioners is that there is often uncertainty about the prognosis of acutely ill and deteriorating patients. Degree of responsiveness to treatment is unknown and, if a positive response is seen, in what time frame. Historically, this lack of recognition has been compounded by inadequate care planning for the last days of life.³