Table 1

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