Critical Matters End of Life Care in the ICU
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Jul 25, 2019 
Dr. BJ Miller, a palliative care physician and Zen Hospice Project leader known for humane end-of-life advocacy. He explores why clinicians avoid talking about death, the role of palliative care in the ICU, how to center patient values rather than code-status checklists, and simple bedside practices that honor dignity and ease family suffering.
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Medical Training Makes Death Hard To Talk About
- Medical training emphasizes fixing disease, leaving clinicians unprepared to sit with suffering when cures fail.
- BJ Miller highlights the ICU as an extreme, artificial environment that amplifies this training bias and makes talking about death harder.
Use Goals Of Care Not Just Code Status
- Treat code status as a narrow, situational decision about what to do when a patient is actively dying, not as a measure of overall care quality.
- Use goals of care conversations over time to elicit values and match treatments to patient priorities across disease stages.
Palliative Care Versus Hospice Clarified
- Palliative care is the interdisciplinary work of helping people feel as well as possible during serious illness and is not limited by prognosis.
- Hospice is a subtype focused on final months with Medicare rules requiring prognosis ≤6 months and cessation of curative intent.
