# Culture, ethics and clinical practice for intensivists managing end of life care: an Australian perspective

## TL;DR

This paper discusses how Australian intensivists manage end-of-life care in the ICU with a focus on ethics, communication, and patient-centered practices.

## Contribution

The paper highlights the unique Australian approach to end-of-life care in ICU, emphasizing cultural humility and legal adherence.

## Key findings

- Australian ICU practice emphasizes patient-centered end-of-life care aligned with ethical and legal standards.
- Intensivists in Australia must maintain advanced communication and ethics training throughout their careers.
- National guidelines and legal frameworks support ethical decision-making in end-of-life care.

## Abstract

Death and dying are significant and impactful, for individuals, families and broader society. For clinical teams working in the intensive care unit (ICU), caring for a dying patient and supporting their family are an important part of their professional role. Australian ICU practice has evolved over several decades to optimise end of life care, so that it is patient centred and adheres to accepted ethical standards as well the established legal framework. In addition to acquiring necessary technical skills, intensivists working in Australia must complete training in advanced communication as well as clinical ethics and are required to maintain competence in these domains for the duration of their professional lives. Important considerations for Australian intensivists managing end of life care include cultural humility, avoidance of assumptions, respectful curiosity, prioritising individual patient values and preferences, and the avoidance of non-beneficial treatments that may simply prolong dying or contribute to suffering. As well as having a legislated legal framework, Australia has endorsed national guidelines developed by relevant the specialist training colleges and intensive care professional societies.