The Acute Physiology and Chronic Health Evaluation System

advice of the intensive care team. Under these circumstances it may be reasonable to continue support for a predetermined period, following which the situation is reassessed with the family. On the rare occasions when confl ict cannot be resolved, a second opinion, perhaps from a clinician from another institution, or an ethics consultation may be helpful. Occasionally it may be advisable to obtain legal advice. Finally the importance of adequate documentation of the decision-making process, of audit and of training for medical and nursing staff in end-of-life care must be emphasized.