End-of-life and palliative critical care (End-of-life and palliative care in intensive care)

What is end-of-life and palliative critical care?

Intensive care can do a great deal, but it cannot help everyone. Sometimes, despite every effort, a person becomes more and more unwell, and the treatments that are keeping them alive are no longer helping them get better — they are only prolonging the dying process and may be causing discomfort. When this happens, the focus of care gently changes from trying to cure to making sure the person is comfortable, peaceful and treated with dignity.

This is called palliative or end-of-life care. It does not mean giving up or withdrawing care — the person is cared for just as closely, but the goal changes. Treatments that are no longer helping, such as a breathing machine, dialysis or drips, may be stopped or not started, while everything that keeps the person comfortable continues.

Importantly, withdrawing treatment that is no longer helping is about comfort, not about hastening death. The aim is to remove burdensome treatment and let nature take its course peacefully, while making sure the person is free of pain and distress. Medicines used to relieve symptoms are given to comfort, not to end life.

These decisions are made carefully and never alone. The intensive care team, often with the palliative care team, weighs the benefits and burdens of treatment, considers what the person would have wanted, and involves the family closely. The person's comfort and dignity, and the family's involvement and support, are at the centre of everything.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your treatment

• Ask the team to explain, clearly and gently, why the focus of care may be changing and what it means.
• Share anything you know about the person's wishes, values, and any advance care plan, advance decision or lasting power of attorney for health.
• Tell the team who is closest to the person and who should be involved in conversations and updates.
• Ask how comfort will be kept, what you might see, and how long things may take — though this is often uncertain.
• Let the team know of any cultural, religious or spiritual needs, and ask for a chaplain or faith leader if wanted.
• Think about who you would like with you, and ask about being present, staying overnight, or bringing children to say goodbye.
• Look after yourself too — ask staff for breaks, drinks and somewhere to rest.

What happens

When the team is concerned that intensive treatment is no longer helping, senior doctors review the situation carefully, often with the palliative care team. They weigh the likely benefits and burdens of continuing, and consider what the person would have wanted. Nothing is rushed, and the family is involved throughout.

If the decision is to focus on comfort, the team explains this gently and answers your questions. Treatments that are no longer helping may be stopped or not added, while everything that keeps the person comfortable continues — pain relief, medicines to ease breathlessness or agitation, mouth care and gentle nursing. Alarms and unnecessary monitoring are often turned off to create a calmer, more peaceful space.

Families are usually encouraged to be present, to talk to and touch their loved one, and to have privacy and time. The team makes sure the person looks comfortable and treats any distressing symptoms promptly. Spiritual and emotional support can be arranged.

How long this takes varies a great deal — sometimes hours, sometimes longer — and the team will be honest that it is hard to predict. Their commitment is that the person will be kept comfortable and treated with dignity, and that the family will be supported.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The hardest parts are usually the grief, the uncertainty over timing, and sometimes disagreement about the right path. None of these mean the wrong decision is being made. Ask the team to be honest about what they expect, to keep the person comfortable, and to give your family time and support. If you are unsure or unhappy, it is always reasonable to ask for more discussion or a second opinion.

Published figures to discuss

It is rarely possible to predict exactly how long someone will live once the focus of care changes, and survival is not the measure of good care here. Putting numbers on time-to-death would be both unreliable and unkind. What matters, and what the team focuses on, is keeping the person comfortable and dignified and supporting the family — so we describe this in plain words rather than figures.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

This section is about the person's comfort and the family's support, rather than physical recovery. The aim is a peaceful, dignified end of life and care for those who love them, before and after death.

• The person becoming sleepier and less responsive as a natural part of dying
• Breathing patterns changing, sometimes becoming noisy, without causing the person distress
• Needing little or no food or drink, which is normal and not uncomfortable at this stage
• Cooler hands and feet and changes in skin colour as the body slows down
• A mix of intense emotions for the family — there is no right way to feel

Aftercare

• Spend time with your loved one, talk to them and touch them — hearing and a sense of presence may remain.
• Ask staff to explain anything you see or do not understand; nothing is a silly question.
• Tell the team at once if your loved one looks uncomfortable, so symptoms can be eased.
• Accept support — chaplaincy, faith leaders, and the palliative care team are there for you too.
• Take breaks, eat and rest; caring for yourself is not letting your loved one down.
• Ask about practical matters and bereavement support when you are ready.
• Keep contact details for support services and for asking the team questions afterwards.

• Knowing who in the team to ask for updates and answers
• Any advance care plan, advance decision or power of attorney shared with the team
• Cultural, religious or spiritual wishes made known
• Decisions about who would like to be present, including children if wished
• Contact details for bereavement support (for example Marie Curie, Cruse)
• Somewhere to rest and take breaks identified
• A way to ask the team questions later if you need to

⚠ Get urgent help if…

• Any sign that your loved one looks in pain or distressed — tell staff straight away so it can be eased
• Breathing that seems to be causing distress (not just noisy breathing, which is usually not distressing)
• Agitation or restlessness that is not settling
• Feeling that your family's questions or concerns are not being heard — ask to speak with a senior doctor
• If you are struggling badly with your own distress or grief — please tell staff, who can get you support
• Thoughts of self-harm at any time, for yourself — seek help urgently from staff, your GP, or the Samaritans on 116 123 (free, any time, from anywhere in the UK). For urgent advice you can also call NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good outcome in this most difficult situation is that the person is comfortable, peaceful and treated with dignity, that their wishes are respected, and that their family is involved, informed and supported. The measure of good care here is comfort and compassion, not survival.

Care focused on comfort relieves suffering and allows a natural death with dignity. It does not, and is not intended to, hasten death — the medicines used are to ease symptoms. The team cannot always predict how long things will take, but they can promise to keep the person comfortable and to care for the family throughout.

How long someone lives after the focus of care changes varies greatly and is often impossible to predict — it may be hours or days, and occasionally longer. This uncertainty can be very hard for families. What stays constant is the commitment to keep the person comfortable and dignified, and to support those around them, for as long as is needed.

Related tests, treatments or support

End-of-life care in intensive care usually involves the critical care team and the hospital palliative care team working together, with chaplaincy and bereavement support. Where appropriate, care may continue in a quieter side room, a ward, at home, or in a hospice. Charities such as Marie Curie provide information and support for families.

Follow-up & long-term care

Families are offered support around the time of death and afterwards, including practical guidance and bereavement services. Many units offer a chance to meet the team again later to ask questions about what happened. Your GP and community services can also provide ongoing bereavement support.

Repeat, follow-on and what comes next

• Comfort medicines are adjusted as often as needed to keep the person settled.
• A time-limited trial of treatment may end in either improvement or a move to comfort care.
• Plans are revisited if the person's condition changes or the family needs more discussion.
• Care may move to a different setting, such as home or a hospice, if that is what the person and family want.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Honest, gentle, plain-language conversations with the family throughout.
• Prompt relief of any pain or distress, with comfort always the priority.
• Privacy, time and the chance for the family to be present and say goodbye.
• Spiritual, religious and emotional support offered to the person and family.
• Clear bereavement support and the chance to ask the team questions afterwards, including signposting to Marie Curie and Cruse.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Palliative and end-of-life care is part of routine hospital care rather than a separately priced treatment
• Whether care continues in intensive care, a side room, a ward, at home or in a hospice
• Input from the palliative care team, chaplaincy and bereavement services
• Any community or hospice support arranged if the person moves out of hospital
• Comfort medicines and nursing care, which are part of standard care

• How the hospital provides comfort-focused care and involves a palliative care team
• Whether the family can be present, stay overnight, and have privacy
• What spiritual, religious and bereavement support is available
• Whether care can continue elsewhere (side room, home or hospice) if wished
• How the family can raise concerns or ask for a second opinion
• What follow-up and bereavement support is offered afterwards

On the NHS? End-of-life and palliative care in intensive care is a core part of NHS care, supported by hospital palliative care teams, chaplaincy and charities such as Marie Curie; it is provided wherever the person is being cared for.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• Can you explain, in plain words, why the focus of care is changing?
• How will you make sure my relative is comfortable and free of pain?
• What might we see, and how long might this take?
• How can our family be involved, and can we stay with them?
• Can we speak with the palliative care team, a chaplain or a faith leader?
• What support is there for us, now and afterwards?
• If we are unsure, can we have more time or a second opinion?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for end-of-life and palliative critical care

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: GMC — Treatment and care towards the end of life ICUsteps — End of life information Marie Curie — What to expect in the last days and hours of life Marie Curie — Eating and drinking when someone is dying Faculty of Intensive Care Medicine — Guidelines for the Provision of Intensive Care Services (GPICS) NICE NG31 — Care of dying adults in the last days of life nidirect — Urgent and emergency care services nidirect — GP out-of-hours service

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.