End of life in intensive care

Page Navigation

This document provides information on what may occur at the end of life for someone in an intensive care unit (ICU). It covers the care and support provided, including what might be experienced during the final hours or days. Our aim is to help prepare you if a family member, partner, or friend is critically ill in the ICU and if their prognosis is uncertain.

We use the terms Intensive Care or ICU (Intensive Care Unit) in this document, although some hospitals refer to it as the Critical Care Unit. The healthcare professionals attending to the patient are referred to as the ‘care team’ or ‘ICU team’.

You do not need to read the entire document at once. Feel free to review the sections that are relevant to you at your own pace. The contents list will help you navigate to the parts that are most useful. The ICU staff will also support you and answer any questions you may have.

Intensive care treatments support individuals in severe conditions with medications and devices (such as ventilators). Unfortunately, there are times when a person’s illness is too advanced for recovery. If the treatment is no longer beneficial, the care team will discuss the next steps and explain how the patient will be cared for in their final moments.

A major challenge in critical illness is the uncertainty about who will recover and who may not survive. Often, the ICU team can only monitor the patient’s response to treatment.

It can be a very frightening time when there are no clear answers.

This period can be extremely tough for family, partners, and friends, who may be anxious about what lies ahead. They might struggle with the uncertainty of whether to prepare for a loved one’s death or their recovery. It can feel like an emotional rollercoaster, with fluctuating news and conditions changing rapidly. Although it may seem like the doctors should have a definitive answer, critical illness is often unpredictable. It is a deeply unsettling experience when clear answers are not available.

Patients at the end of their life in the ICU will be treated with the utmost dignity and respect, as if they were expected to recover.

How does the ICU team determine if a patient is nearing the end of life in the ICU?

In the ICU, patients are often supported by various machines and medications, collectively known as 'life support' or 'life-sustaining treatment.' Patients may be semi-conscious or under strong sedation (an 'induced coma'), which can make it difficult to gauge their worsening condition. The ICU team monitors vital signs, heart rate, blood test results, and the level of assistance needed for breathing and blood pressure to assess if the patient's condition is improving, stable, or deteriorating.

Recognizing when a patient is nearing the end of life ensures they receive appropriate care and support during this period.

If a patient's condition worsens despite ICU support, continuing intensive treatment may no longer be in their best interest. ICU care can be distressing and may lead to long-term complications without improving the patient's quality of life. If the treatment proves ineffective or the patient's quality of life is not likely to improve, the focus may shift from curative to palliative care to ensure their comfort and dignity.

Deciding to discontinue intensive care does not mean the patient will lack support. Instead, they will receive compassionate care tailored to their end-of-life needs.

How is treatment decided for a patient who cannot communicate their wishes?

When a patient is unable to make their own decisions due to severe illness, the 'Best Interests' process is used to determine the most appropriate care. This involves collaboration between healthcare professionals and individuals who know the patient well, such as family or partners. The ICU team will assess the available treatments and evaluate whether each option aligns with the patient’s best interests, seeking input from those close to the patient.

To determine what is in the patient’s best interests, the ICU team will gather information from other medical experts familiar with the patient’s condition, as well as from those who know the patient personally. They will consider the potential benefits and drawbacks of different treatments, weighing what improvements might be made against possible suffering or harm.

As part of this process, you may be asked about the patient’s previous thoughts on illness and treatment, and any conversations you had with them before their illness. This helps the medical team understand the patient's possible preferences, although these may differ from the views of family or friends. Your role is to provide insights into the patient’s previously expressed wishes, rather than making the final treatment decision. It’s acceptable to admit if you’re unsure about what the patient would have wanted.

The medical team may also inquire whether the patient had previously completed any forms indicating their preferences, such as refusing cardiopulmonary resuscitation (CPR) or certain life-sustaining treatments, or if they had discussed their wishes with others through Advance Statements or Advance Care Planning.

If the patient designated someone to make decisions on their behalf through legal Powers of Attorney, that individual or group can make decisions regarding treatment, similar to the patient’s rights. If no Powers of Attorney are in place, the senior doctor in charge will make the decisions. However, decision-makers cannot request specific treatments; they can only accept or refuse the options presented by the ICU team.

If decisions about the patient’s best interests are required, the care team will guide you through the process and involve those close to the patient to ensure a well-informed decision. It may take several discussions to reach the most appropriate conclusion.

Further information is available if you have concerns about the treatment plan.

What is Power of Attorney?

Power of Attorney is a legal arrangement that allows a person to designate one or more individuals to make decisions on their behalf if they are unable to do so. In England and Wales, this is known as Lasting Power of Attorney for Health and Welfare, while in Scotland and Northern Ireland, it is simply referred to as Power of Attorney. If the appointed Attorney(s) are authorized to make decisions about life-sustaining treatments, they should be involved in the process of determining the patient's best interests and consulted about their preferences. While they can refuse specific treatments for the patient, they cannot demand or request particular treatments.

In the absence of a legal Power of Attorney, no one, including partners, family members, or parents, has the authority to consent to treatment on behalf of an adult over the age of sixteen.

Where a person is cared for at the end of their life

When it is clear that a person is nearing the end of their life, or if continuing intensive care is no longer beneficial, the medical team will consider the most suitable setting for their care. You may be consulted about the person's preferred location for their final moments. If intensive care is no longer required, the patient might be transferred to a general ward.

In some cases, it might be possible for the person to be moved to their home or a hospice, depending on their condition, care requirements, and the time available to arrange this transition.

The ICU team will discuss with you the options for the patient's care setting. The palliative and supportive care team may also be involved to provide guidance on managing symptoms and ensuring comfort.

What occurs in 'ordinary' dying?

When a person is nearing the end of their life outside of an intensive care unit, such as at home or in a general hospital ward, certain common changes and stages can be observed. Although there may be some uncertainty regarding the exact timing of death, it is generally easier to recognize the end-of-life stages in the absence of intensive care treatment.

A person who is dying may:

  • become increasingly fatigued and sleep more
  • have difficulty swallowing or taking oral medications
  • lose interest in eating and may stop eating
  • consume less fluids and may eventually stop drinking
  • feel warm or cold to the touch
  • experience confusion or disorientation
  • exhibit heightened emotional responses
  • show a reduced desire to communicate or see others
  • display a lack of interest in their surroundings
  • become too weak to leave their bed and may need absorbent pads
  • occasionally become agitated or restless
  • fall into unconsciousness, appearing asleep but difficult to rouse

Breathing patterns often change as death approaches, including:

  • irregular breathing patterns, such as alternating between rapid and slow breaths, or fluctuating between deep and shallow breaths, with possible pauses
  • noisy breathing, sometimes referred to as a 'death rattle'. Medication can be administered to alleviate this if it causes discomfort, though many patients find it non-distressing. It may indicate that the patient is at ease and not troubled by mucus in their throat, as they do not exhibit coughing or gagging.

What occurs when someone passes away in the ICU?

When a person dies in the ICU, some aspects of the process are similar to ordinary dying, but there are additional considerations due to the presence of machines and life-support treatments.

The care team will focus on making the dying process as comfortable as possible for the patient. This involves transitioning from life-sustaining treatments to comfort measures. The ICU team will discuss with you the changes in care, including the discontinuation of breathing support and other machines or medications that are no longer beneficial to the patient.

The care team will strive to ensure the dying process is as comfortable as possible for the patient.

If the team determines that certain machines and medications are no longer useful, such as those that support blood circulation, they will plan to remove them. They will assess the patient’s condition and provide alternative support to maintain comfort. The nursing staff will continue to provide attentive care, just as they did with life-sustaining treatments.

Nurses may remove intravenous drips and lines if they are no longer needed. As the end of life approaches, frequent monitoring of blood pressure, heart rate, and oxygen levels may become less critical. This might be concerning to family members who are used to seeing these measurements closely monitored, but the focus will shift to ensuring the patient’s comfort and managing any symptoms that could cause discomfort.

What changes might occur in a person nearing the end of their life in the ICU?

As a person approaches the end of their life in the ICU, you may observe various changes in their appearance and condition.

Medications can be administered to address discomfort, but excessive use may lead to side effects. For instance, pain relief medications might cause nausea or abdominal pain, so the care team will carefully manage medications to maximize comfort.

Here are some changes that might be observed at the end of life in the ICU:

Changes in Breathing

Alterations in breathing patterns are a natural aspect of the dying process. Breathing may become slower, faster, noisy, or irregular. If a ventilator is being used, these changes might not be noticeable. When ventilators are no longer needed, the care team will carefully plan how to withdraw this support. Some individuals may not be able to breathe independently once the ventilator is removed, leading to rapid decline, while others may initially breathe on their own before their breathing gradually slows.

In cases where breathing becomes noisy, medications can be administered to alleviate discomfort.

Breathlessness

If the person is conscious, they may experience breathlessness, which can cause anxiety or distress. Simple measures, like using a hand-held fan, may provide relief. Medications might also be given to manage severe breathlessness if it causes significant discomfort.

Mucus (Phlegm)

Mucus buildup in the lungs is common in ICU patients who are unable to cough effectively. If a tracheostomy tube is in place, nurses may use suction to remove mucus, though this procedure can be uncomfortable. When transitioning to comfort care, suctioning may be discontinued if it causes distress, and alternative measures such as adjusting the patient’s position or administering medication may be used to alleviate discomfort.

Skin Changes

As some treatments are ceased, changes in skin appearance may occur due to altered blood circulation. The skin might appear pale, mottled, or feel cool, especially around the extremities. Nurses will monitor the skin closely to prevent pressure sores by frequently repositioning the patient and using appropriate skin care measures.

Pain

The nursing team will aim to keep the patient free from pain and as comfortable as possible, regularly checking for signs of discomfort. Pain management may involve medications administered via drip or subcutaneously. If you notice signs of pain, inform the care team.

The care team will work to keep the person free from pain and ensure their comfort throughout the dying process.

Sometimes discomfort or restlessness can be managed by adjusting the patient’s position in bed.

Seeming Upset

Restlessness, agitation, and confusion are common at the end of life. The care team will investigate potential causes such as pain and adjust treatment accordingly. Medications may be used to manage these symptoms, which could result in increased drowsiness. The goal is to find a balance between comfort and awareness.

Delirium

Delirium, characterized by acute confusion and vivid hallucinations, is common in ICU patients, particularly those nearing the end of life. It can be distressing for the patient and their loved ones.

To assist someone experiencing delirium, consider:

  • Holding their hand and offering reassurance
  • Reminding them that they are in a safe place, such as a hospital
  • Using a calm, soothing voice during conversations
  • If they are sedated, reading familiar material to them, ensuring it is comforting and not distressing
More information on delirium can be found in our information sheet Delirium in ICU.

Sickness

Vomiting or nausea at the end of life can result from the illness itself or as a side effect of medications. There are medications available that can help alleviate these symptoms if they cause significant distress.

Emptying Bowels (To Poo)

As a person becomes more ill, they may lose the ability to get out of bed to use the toilet. They might experience loss of bowel control or discomfort from constipation (difficulty passing stools). Diarrhoea (watery stools) can also occur. The care team will assess the situation and provide appropriate treatment to manage discomfort.

Emptying Bladder (To Wee)

Most ICU patients have a catheter inserted into their bladder to drain urine. This helps maintain comfort and prevents the sensation of needing to urinate.

Eating and Drinking

Many ICU patients are not well enough to eat or drink and may receive nutrition through a feeding tube or intravenous (IV) fluids, known as clinically assisted nutrition and hydration (CANH). As dying progresses, the need for food and drink decreases naturally. If CANH is causing discomfort, such as distention of the stomach, the care team may decide to discontinue it. This decision is made with the patient’s comfort in mind. Families should discuss any concerns with the ICU team.

Feeling Hungry

In the later stages of life, patients may be too sedated or sleepy to feel hunger. However, if a patient appears uncomfortable due to hunger, the care team will monitor and address this issue to ensure comfort.

Feeling Thirsty and Mouthcare

Thirst and dry mouth are common as a person nears the end of life. Nurses will provide mouth care to enhance comfort, including using wet swabs to moisten the mouth and lips, applying ice (if allowed), using mouth sprays, lip moisturizers, and gentle tooth brushing. You can ask the nurses if you can assist with mouth care, and they will guide you if it's appropriate.

What else can be important to people at the end of their life?

Communication (Talking with) Your Relative, Partner, or Friend

The person who is dying may appear to be asleep or unconscious due to natural sleepiness, sedation, or strong medications. Even if they seem unresponsive, talking to them can be reassuring. They might still be able to hear you, and hearing your voice can provide comfort. Inform them that they are in the hospital and that you are with them, especially if they seem confused about their surroundings.

Maintaining a one-sided conversation can be challenging. You might consider reading a calming book or newspaper to them or playing music they enjoy. Music can help soothe and comfort them if they appear upset or restless.

It might be possible to make a more peaceful space around their bed for the person who is dying
If you have things to say to the patient but find it difficult due to their inability to respond, you might speak to someone else in the room so that the patient can hear. This could be a nurse or another visitor.

If the person is more awake, they might be able to communicate through writing or pointing to a board. They may be confused or delirious, so their responses might not be clear. Continue to reassure them that they are in the hospital and being cared for. Speaking calmly and gently can also help comfort them.

Area Around Their ICU Bed

Creating a peaceful environment around the bed can be beneficial. For example, turning screens away from view and reducing alarm volumes can help create a more serene space.

Occasionally, it may be possible for ICU teams to take patients outside for fresh air if it's safe and feasible, though not all units can offer this option.

Other comforting elements might include:

  • Pet therapy (with specially trained animals)
  • Soothing lighting (such as lamps)
  • Personal belongings (like pillowcases or blankets, subject to infection control policies)
  • Familiar music
  • Preferred scents (such as perfume, aftershave, or essential oils)
  • Photographs of family, friends, or special places

Religious and Spiritual Needs

If religion or spirituality is significant to the person, inform the care team. They might be able to accommodate these needs, such as:
  • Bringing religious icons or pictures
  • Reading prayers or religious texts to the person

A religious leader or community member may visit the patient if it would be comforting. This can be arranged through hospital Chaplains, who also offer spiritual and non-religious support. Contact the care team to reach out to a Chaplain.

Cultural Needs

If there are specific cultural rituals or practices important to the person at the end of their life, communicate these to the nurses. This might include activities like meditation or reading poems. The care team will do their best to accommodate these needs within the ICU’s capabilities.

There may also be cultural customs for post-death care. Inform the care team about these customs to see if they can be observed.

What else might it be helpful to know about end of life in ICU?

Visiting

Some friends, partners, or relatives may prefer not to visit a loved one in the ICU, especially if they find it upsetting. Instead, they might choose to stay updated through family members. Alternative ways to say goodbye include phone calls, voice messages, or sending cards and pictures.
Even if the person who is dying is not able to speak, hearing a voice of someone close to them could be comforting

When Visiting Is Not Possible

Sometimes, visiting may not be allowed due to infection outbreaks or the patient’s infectious disease. If visiting is not possible, designate one person to stay in contact with the ICU team. This person can receive updates and share information with other friends and family members.

If a visit isn’t possible but someone important to the patient wishes to connect, a video or phone call might be arranged. Hearing familiar voices can provide comfort even if the person cannot respond.

If a video call is planned, prepare for the possibility that the patient may look different from their last visit. They may have tubes, or appear confused or agitated. Speak with a nurse beforehand to understand what to expect.

If visiting isn’t possible, consider recording a voice message or arranging for a nurse to read a card or letter to the patient.

Children

Discussing a loved one’s critical condition with children can be challenging, but honesty is usually the best approach. Use language appropriate to their age and avoid euphemisms like "asleep" for death. Reassure them that the patient is receiving care from the ICU team.

Reassure them that the patient is being looked after and cared for by the ICU team
Consider whether it is appropriate for children or young people to visit the ICU. Consult with the ICU staff beforehand. If a visit is deemed appropriate, ensure the child is prepared for what they will see and provide support throughout the visit. Make sure they have an adult to support them and prepare them for the sights, sounds, and smells they might encounter. Let them know they can leave anytime if they feel overwhelmed. This preparation is also crucial for virtual visits.

After the visit, children may have questions. Doctors and nurses might help answer some of these. Ensure the child receives emotional support, as the experience can be distressing.

If a child or young person does not wish to visit, they can still make a voice message, or create a card or letter. This can help them feel connected to the person in the ICU.

Medicine Given to Help the Person Who Is Dying Be More Comfortable

The care team will administer medication to ensure the person who is dying is as comfortable as possible. They will assess symptoms, such as noisy breathing, and determine if medication is needed to alleviate discomfort. The goal is to balance the amount of medication to manage symptoms effectively while minimizing any unpleasant side effects.

When a Person Will Die

Predicting the exact time of death can be challenging. It might happen quickly or take longer, and while the staff may provide an estimate, precise timing is difficult to determine. This uncertainty can be frustrating, especially when arranging for visitors or managing personal time.

Knowing when to take breaks for rest, meals, or hydration can be tough. It is important to take care of yourself as well, even though it may be hard to step away. The nursing staff will notify you if there are any significant changes in the patient's condition.

When a patient is connected to several machines and they are no longer in use, death may occur very quickly, possibly within minutes or a few hours. The ICU team can inform you about when these machines are scheduled to be stopped.

Organ Donation

If it has been decided that life-sustaining treatments are no longer in the person's best interest, organ or tissue donation may be considered. A specialist nurse in organ donation will provide information and discuss the option with you.

DNACPR and Decisions Not to Have Life-Sustaining Treatments or to Stop These Treatments

Some treatments may not benefit the person or may cause harm, especially if they are already very ill. For example, CPR (cardiopulmonary resuscitation) involves chest compressions and possibly electric shocks to restart the heart. It may not be effective in a dying person and could cause further harm.

The patient may have previously decided against CPR and have a DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) order. They might also have indicated other treatments they do not wish to receive through forms like the RESPECT form. More information on Advance Care Planning and CPR decisions can be found on the Talk CPR website.

A DNACPR decision is only about CPR. It does not stop any other treatments being considered or given to the person

The ICU team will evaluate if a DNACPR (Do Not Attempt CPR) order is necessary if one is not already in place. This order means that CPR will not be performed if the heart stops. This might be due to the patient's severe illness or conditions that would render CPR ineffective (e.g., brittle bones or severe chest conditions). DNACPR decisions are intended to prevent unnecessary distress if CPR is unlikely to be beneficial.

DNACPR decisions are specifically related to CPR and do not impact other treatments. The care team may also discuss other treatments that may no longer be appropriate, such as intubation or mechanical ventilation. Each treatment will be reviewed to determine if it is beneficial or harmful to the dying person.

Social Media

Families may wish to share updates or photos on social media for those who cannot visit. However, it is crucial to obtain permission from the person who is dying before posting any pictures or information. If the individual is unable to provide consent, do not post any images or details about them.

What family, partner, and friends can do to support the person who is dying

Speak to the person’s care team to see if there are ways you can support the person who is dying. You might be able to:

  • gently reassure the person by talking to them, reading to them, or just being with them
  • hold their hand
  • give mouth/eye care and help with hygiene care, such as hair washing and brushing
  • give a hand or foot massage
  • make a video or phone call so they can hear the voices of important people in their life
If you try some of these, observe how the person responds and stop if it does not seem to comfort them. Consider the following:
  • Do they have a religious belief that is important to them?
  • Do they have cultural needs, specific beliefs, or things they would want to happen before or after their death?
  • What might be comforting for them to have with them, such as photos?
  • Are there any changes to the bed space that could be made, such as lower lighting or music they like, if possible?
If you are unsure whether the person may die or live, consider these aspects just in case they are needed.

What family, partner, and friends can do to support the person who is dying

Speak to the person’s care team to see if there are ways you can support the person who is dying. You might be able to:

  • gently reassure the person by talking to them, reading to them, or just being with them
  • hold their hand
  • give mouth/eye care and help with hygiene care, such as hair washing and brushing
  • give a hand or foot massage
  • make a video or phone call so they can hear the voices of important people in their life
If you try some of these, observe how the person responds and stop if it does not seem to comfort them. Consider the following:
  • Do they have a religious belief that is important to them?
  • Do they have cultural needs, specific beliefs, or things they would want to happen before or after their death?
  • What might be comforting for them to have with them, such as photos?
  • Are there any changes to the bed space that could be made, such as lower lighting or music they like, if possible?
If you are unsure whether the person may die or live, consider these aspects just in case they are needed.

How family, partner and friends can look after themselves during this time

Having someone very ill in the ICU is a difficult and upsetting time. It is important that you take care of yourself too. This includes having time to rest, eat and drink, though it can feel hard to leave the person to do these things. Other things that may help you are:

  • asking friends and family to support you. You can ask for specific things, such as lifts, food to be cooked, jobs to be done to help you, or just to be there if you ask for help.
  • speaking to the hospital chaplain who will talk with you and listen to you, even if you do not want religious support.
  • speaking with someone from a religious community, such as an Imam or a Vicar. They might be able to provide non-religious (pastoral) support as well.
  • asking a friend or family member to send emails or messages to let other family and friends know what is happening, so you can focus on being with the person who is dying and taking care of yourself.
  • speaking with the nurses and doctors if there are things you want to know.

If you have concerns about the person’s treatment plan

When someone is too unwell to express their treatment preferences, legal guidelines state that decisions regarding their care must be made by the senior doctor responsible or by an appointed individual with Power of Attorney, following a best interests process.

After a treatment plan is established based on the best interests process, you or others, like family or friends, may feel a different approach would be more suitable. Sometimes, there may be disagreements among you, family members, or friends about what the most appropriate care should be.

Having a loved one in the ICU is a challenging and emotional experience.
If there are concerns or disagreements regarding the care and treatment, it’s important to discuss them with the medical team. The ICU staff will provide explanations for their decisions, aiming for mutual understanding. If you remain concerned, you can request a conversation with the Matron or the ICU’s Clinical Director. Additionally, the hospital chaplain or the Patient Advice Liaison Services (PALS) might offer assistance. Seeking a second opinion from a trusted doctor, or asking the ICU team to arrange one, is also an option. It is generally best to resolve any concerns within the hospital setting if possible.

Should your concerns persist after speaking with the Matron or Clinical Director, there are local mediators, such as the Clinical Ethics Committee or independent experts, who may facilitate a second opinion. PALS can help provide contact information for these mediators. In rare situations where agreement on the treatment plan cannot be reached, the matter may be escalated to the Court of Protection for resolution.

What to expect after the person passes away

After someone passes away, a doctor will confirm their death, and the nurses will ensure your loved one continues to be respectfully cared for. They will then be transferred to the hospital mortuary, where deceased individuals are taken.

If you wish to assist with care after your family member, partner, or friend has passed, such as washing them, ask the nurses. This may hold personal, cultural, or religious significance. It is entirely optional, as the nurses can handle it, but they can support you if you choose to participate.

Should you like a memento, such as a handprint, fingerprints, or a lock of hair, you can request this from the nursing staff, if possible.

The deceased person will be moved to the mortuary soon after passing, usually within one to two hours, as they must be kept in a cool environment. They will remain there until arrangements are made by you or a family member with a funeral director to collect the body.

As the next of kin (the individual listed to be informed upon hospital admission), you can take the person’s belongings home when you leave the hospital. Alternatively, their possessions will be kept for you to collect later. Be sure to ask where their belongings are stored, as it may not be in the ICU or the ward where the person passed away.

If the person recently underwent treatments like surgery or chemotherapy, or if there are questions surrounding the cause of death, a Coroner may review the case. The Coroner, a legal official who investigates certain types of deaths, may need to examine the situation further. This is not uncommon, and the hospital's Bereavement Services will contact you if this happens. If a Coroner’s involvement is required, funeral arrangements may be delayed, but the Bereavement Office will provide more details.

You may reach out to Bereavement Services (or they may contact you) to schedule an appointment to collect the medical certificate of death. However, if the Coroner is involved, the certificate will only be issued after their investigation is completed.

The Bereavement Services team will also guide you through next steps, such as registering the death and choosing a funeral director. They can answer any questions you might have and inform you whether the medical certificate of death will be available for pickup or sent to you directly.

Will the ICU reach out after the person has passed?

Sometimes, a member of the ICU team may contact the family after a loved one passes away. This may be to address any questions or offer support. They can help clarify aspects of the death that may be unclear or difficult to remember.

They understand that it may be difficult for you to discuss or that you may not feel ready to talk. You are not obligated to speak with them. It is common for people to have questions sometime after the death, especially when reflecting on the circumstances. Often, events at the time can be overwhelming, especially if the passing happened quickly.

If you have questions and haven’t been contacted by the ICU, feel free to reach out to the hospital’s Bereavement Services or the Patient Advice and Liaison Service (PALS). You may also contact the ICU directly if they provided you with follow-up contact information after your loved one’s passing.

How you might feel after losing someone

The death of someone close can stir up many emotions. You may feel a wide range of things, including devastation, anger, disbelief, numbness, exhaustion, helplessness, and profound sadness. These feelings may take time to surface, and your emotions could shift from day to day or even hour to hour. Grief is a process that requires time, and there’s no 'right' or 'wrong' way to feel. Those around you who are also grieving may experience or express their emotions differently from you.

Losing someone close can bring a flood of different emotions.

Grief

Grief is the emotional response we have when someone we care about dies. People grieve in various ways, and there is no standard or 'correct' way to go through this process.

When a death is unexpected, it can be especially overwhelming because you haven’t had time to prepare. Initially, you may feel numb, as though what happened isn’t real, or you may have vivid flashbacks of moments when the person was in ICU, making it hard to process the reality of the loss.

The experience of losing someone in ICU can trigger powerful and sometimes surprising emotions, especially if the death was sudden. These feelings are part of the grieving process, and it’s important to seek support if you’re struggling to cope. Grief can impact both the body and mind in unexpected ways. You might have trouble sleeping, experience flashbacks, lose your appetite, or feel tempted to consume more alcohol than usual.

Over time, you may want to learn more about what happened during the person’s time in ICU, if this feels helpful to you. You might have unclear memories from that period or find it difficult to recall details. Reviewing this information later could help you better understand what occurred, should you wish to do so.

Questions you may have during and after someone’s stay in ICU

How might I feel while someone is in ICU?

This is an incredibly challenging time for you and the person's friends and family. It’s possible that the severity of their illness was unexpected, or that it occurred suddenly, leaving you little time to prepare. Not knowing how the person will respond to treatment or if they will recover can be very difficult to cope with.
Lean on the people around you for support. Your well-being matters too.

It’s natural to feel desperate for clear answers, even when none are available. You might feel uncertain about the best course of treatment, and the person may be too unwell to communicate their preferences. You may question why the treatment isn’t working, struggle to believe the situation, or even feel frustration toward the medical team for not being able to help more. There may be disagreements about whether additional treatment is in the person's best interest. Fear, sadness, and other emotions may also arise. These reactions are normal, and the staff understand this. They will try their best to answer your questions. Remember to ask for support, as your needs are important too.

What if the person in ICU seems to improve after appearing very ill?

At times, a patient who seems critically ill may show signs of improvement. The care team will monitor their condition closely and adjust the treatment plan as needed. They will keep you informed about any changes or new plans for their care.

What if the person becomes gravely ill while I’m not there?

If the person’s condition worsens while you are not present, and you are the person designated to be contacted, the care team will make every effort to reach you. The nurses will remain with the patient to provide comfort. Sadly, sometimes people can deteriorate quickly, and it may not be possible for you to be there in time. However, the patient will never be left alone and will be cared for with compassion.

Why am I being asked about research?

ICU teams continually seek to improve care for critically ill patients through research. Nearly all ICUs participate in clinical research studies. If the patient is too unwell to consent, you may be asked whether they—or you—would like to participate in a study. The research team will explain the study details, and you will have time to consider whether to take part. Your decision will not affect the patient’s care, and the ICU team will continue to act in their best interest. If you agree to participate but later change your mind, you can inform the care team.

How long can I stay with someone in ICU after they have passed away?

You may spend some time with your loved one after they pass, but they will need to be transferred to the hospital mortuary within a short period (typically one to two hours). The ICU staff understand this can be difficult, especially if the death was unexpected, but the body must be moved to a cool room. You may be able to see your loved one later, either at the mortuary or the funeral home. The ICU team, bereavement office, or funeral director can help you make arrangements if needed.

What is the difference between a medical certificate of death and a death certificate?

After someone dies, a doctor will issue a medical certificate of death. This document is taken to the Registry Office, where the death is officially recorded, and a death certificate is issued. The death certificate is often required by banks, insurance companies, and other institutions for their records. The Registry Office will explain the process in more detail when the death is registered.

Conclusion

Being with someone who is ill enough to require ICU care can be an incredibly challenging and stressful experience. If the person’s condition becomes critical, there may be a lot of complex medical information to absorb. You may be involved in discussions about the patient’s preferences for their care and treatment. While the ICU staff are primarily focused on providing the best care for the patient, they are also there to support you. They understand how difficult this time can be and will do their best to keep you informed about the patient’s condition.

The care teams aim to ensure that the patient’s final moments are as comfortable and dignified as possible.

When a person is nearing the end of life in the hospital, the care teams strive to make their final moments peaceful, ensuring comfort and dignity. This guide has been developed with input from a team that includes a representative for patients and families, a palliative care specialist, and ICU healthcare professionals. We hope that this information helps bring you some clarity and comfort during this difficult time, providing insight into what is happening and helping you focus on what is most important to the person who is dying.

Explore Other Articles