Death and Dying In the ICU: The Chamber of Torture

Manuel Lois Internist Fort Worth, TX

My main are is Intensive Care medicine. I am specifically interested in ARDS and  mechanical ventilation. I alwso have been training in Interventional Bronchoscopy

When patients get sick and seek medical attention, they expect doctors will help them get back to “normal”. Contrary to what many television shows depict, many ICU patients are those with chronic or incurable diseases, often in the terminal stage. When walking through the ICU, you see patients connected to respirators, dialysis machines, numerous IV pumps, and restraints to prevent them from removing that equipment. Families seldom see their loved ones attempting to remove their breathing tube, or grimacing as nursing staff adjust tubes that have been placed into the lungs or stomach, or when they are being treated for bed sores from prolonged immobilization. 

Patients too often suffer in vain attempts to prolong life, because of the mandate to “do everything.” Death and dying does not happen to us, but to someone else”. We have a “replacement mentality” and therefore “Americans not only don’t want to die, they are unwilling to accept the reality of death”.  

Doctors are frequently afraid of facing death and are reluctant to disappoint a patient with the grim truth, and, knowingly or not, keep false hopes alive. Physicians are not educated on death and dying and therefore are not prepared to help patients or families face these critical times.  To make things worse, patients and families not only overestimate the power of modern medicine, they are also often in shock, faced with serious questions and moral dilemmas that are frequently overlooked or considered before tragedy hits.  

Fortunately, two new fields are providing relief to all this tension and providing guidance for families and physicians in navigating these difficult times.   

Bioethics is the philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with ethical questions that arise in the fields of life sciences, biotechnology, medicine, politics, law, philosophy, and theology.  Many bioethicists are philosophers, religious leaders, physicians, nurses, administrators, and lawyers that help bridge the gap between families and physicians, and ease the moral and legal burdens of decisions faced during these times. 

Hospice and palliative medicine focus on improving a patient’s quality of life by managing pain and other distressing symptoms of a serious illness. They provide emotional and physical support for patients and families, helping them have a more natural and dignified dying process.   

Modern medicine can achieve great things, but all too often when patients have no hope of surviving, technology and drugs are still used to simply keep people “alive” as long as possible. 

Both physicians and families need to understand that there is a moral, ethical, and legal right to allow natural death and avoid further unnecessary suffering. Treatment goals should focus on providing emotional and medical support while maintaining quality of life, thus making the final outcome a more pleasant and less painful experience for families and most importantly, the patient.