Update and recommendations in decision making referred to limitation of advanced life support treatment

Med Intensiva (Engl Ed). 2020 Mar;44(2):101-112. doi: 10.1016/j.medin.2019.07.006. Epub 2019 Aug 28.
[Article in English, Spanish]


The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Bioethics Working Group has developed recommendations on the Limitation of Advanced Life Support Treatment (LLST) decisions, with the aim of reducing variability in clinical practice and of improving end of life care in critically ill patients. The conceptual framework of LLST and futility are explained. Recommendations referred to new forms of LLST encompassing also the adequacy of other treatments and diagnostic methods are developed. In addition, planning of the possible clinical courses following the decision of LLST is commented. The importance of advanced care planning in decision-making is emphasized, and intensive care oriented towards organ donation at end of life in the critically ill patient is described. The integration of palliative care in the critical patient treatment is promoted in end of life stages in the Intensive Care Unit.

Keywords: Bioethics; Bioética; End of life; Final de la vida; Limitación de tratamientos de soporte vital; Limitation to advanced life support treatment.

Publication types

  • Practice Guideline

MeSH terms

  • Airway Extubation
  • Burnout, Professional / prevention & control
  • Clinical Decision-Making / methods*
  • Communication
  • Critical Illness
  • Decision Making, Shared*
  • Humans
  • Life Support Care / methods*
  • Medical Futility
  • Palliative Care
  • Quality Indicators, Health Care
  • Resuscitation Orders
  • Terminal Care / methods*
  • Tissue and Organ Procurement / ethics
  • Treatment Refusal
  • Withholding Treatment