PALLIATIVE CARE Dilemmas within the Surgical Intensive Care Unit

The change of death from a moral to a technical matter has come about for many reasons based in social evolution and technical advance, and the ef-fects on the dying have been profound.1 When death is imminent, recognition, avoidance, denial, and readiness can all go hand in hand for the patient, family members and professional staff. Of-ten, no one is ready and death still comes. This is why one faces death rather than masters it.2 The surgical intensive care unit (SICU) is designed to save the lives of patients who are critically ill, but even in a tertiary care hospital a proportion of patients will not survive. Their deaths trouble the relationships among persons who are key actors: physicians (surgeons and intensivists); nurses; persons attached to the patien