July 16, 2026
Palliative Care in the ICU Is a Synergy, Not an OxymoronÂ
I am a palliative care physician who has worked for the past 12 years at a 400-bed public university hospital in Santiago, Chile. When our mobile palliative care team was created, it consisted of a nurse, a psychologist, and myself. Most of our consultations came from general medical wards, involving patients with advanced cancer. Occasionally, we were asked to see patients with nonmalignant illnesses, but referrals from the intensive care unit (ICU) were uncommon.
COVID-19 forced a sea change
Everything changed during the COVID-19 pandemic.
As our hospital converted virtually every available bed into a critical care bed, our team became involved in the care of a large number of critically ill patients, many of whom died despite receiving the most advanced life-sustaining treatments available. Working side by side with intensivists, nurses, respiratory therapists, and many other professionals left a lasting impression on us.
Technologies coexist with mortality
It also reinforced a conviction that has stayed with me ever since: palliative care in the ICU is not an oxymoron, but a synergy. In few places in medicine do the most sophisticated technologies coexist so closely with mortality as an unavoidable reality. Precisely because cure is not always possible, relief of suffering, communication, and support become essential components of high-quality critical care.
A protocol for high-risk patients in the ICU
This experience motivated our research group to develop a standardized palliative care protocol for critically ill adults at high risk of dying in the ICU. In 2023, we conducted a Delphi study to validate its content, bringing together 74 participants from six stakeholder groups: intensive care physicians and nurses, palliative care physicians and nurses, ICU survivors, and bereaved family members. Rather than asking whether palliative care should be integrated into the ICU, we focused on a more practical question: What should a palliative care protocol for these patients actually include?
Patient-guided protocols
Two findings particularly caught our attention. First, ICU survivors expressed greater support for preserving patients' autonomy in decisions about palliative sedation than any other stakeholder group. Their perspectives differed from those of healthcare professionals and family members, reminding us that people who have experienced critical illness often understand these decisions differently. If we aspire to design better end-of-life care, patients' voices should not simply be heard—they should help shape the protocols that guide our practice.
ICU-PC collaboration favored
Second, participants consistently favored a collaborative model in which intensive care and palliative care teams share responsibility for communication, symptom management, and end-of-life care. Rather than viewing palliative care as something that begins when intensive care ends, they envisioned both disciplines working together throughout the care of patients with a high risk of dying.
The most important lesson
Perhaps that is the most important lesson. Developing clinical protocols is not only about reaching technical consensus; it is about creating spaces where clinicians, patients, and families can collectively define what good care looks like. Integrating palliative care into the ICU does not mean doing less. It means ensuring that, even when cure is no longer possible, relief of suffering, respect for patients' values, and compassionate communication remain central goals of care.
Note: This work was presented as an oral presentation at the 2026 Latin American Congress of Palliative Care (ALCP), held in São Paulo, Brazil.