Unspoken signals that staff wish to consider withdrawal of intensive care
| 1. | Standing off on clinical rounds: disgruntled staff turn away as though disinterested in contributing to further management |
| 2. | Exaggeration of clinical signs: overemphasising adverse signs reflects despair that cannot be expressed in another way |
| 3. | Therapeutic nihilism: all suggested treatments are rejected by desperate staff on the basis of their side effects instead of a willingness to consider the balance of risks |
| 4. | The incongruous search for the expert: paradoxically staff may want to call in an “expert” such as a nephrologist or cardiologist to advise on organ system failure (presumably in the hope that a firm lead will be taken to withdraw intensive care) |
| 5. | Group formation among staff: small groups form and discussamong themselves the futility of continuing intensive care |
| 6. | Allegations of parental lack of information: in spite of frequent discussion with parents about their infant's progress, staff insist that the parents haven't been informed and don't know how ill their infant is |