Cuidados paliativos y medicina intensiva en la atención al final de la vida del siglo XXI Palliative care and Intensive Medicine in health care at the end of life in the XXI century

The basic aim of Intensive Care Medicine is care for the critical patient, that is, persons with a disease or condition that is life-threatening but with possibilities of recovery. In spite of the treatments, even those involving life support, cure is frequently not achieved and this is when the question is raised of withdrawing treatment due to criteria of futility. Once that decision is taken, efforts must be directed towards applying the necessary care to achieve an end to life without pain or suffering, endeavouring to ensure that the patient is accompanied by his loved ones. Studies show the shortcomings in training and health care that exist in caring for patients at the end of their lives within the sphere of the Intensive Care Units. This article reviews the contribution that can be made by Palliative Care in improving care for patients that die in the ICU and for their relatives. The ontology of palliative care aims to achieve an improvement of symptoms, the prevention of possible complications, to determine and respect the welfare of the patient, and to help the family in the final process and in mourning. It therefore involves different disciplines from the health field which must work with common aims. In situations of the end of life the knowledge and sensitivity of the professionals must be at the service of faithful commitment to the patient, making it possible to redirect therapeutic efforts towards the proposed aims.