The Triad of Dying: A framework for palliation and compassionate decision-making in the ICU

Background: End-of-life decision-making in the intensive care unit (ICU) remains ethically complex and emotionally charged. There is a need for frameworks that support compassionate, values-based care when curative treatment is no longer appropriate. Methods: This paper introduces the ‘Triad of Dying’, an easy to recall, clinical and ethical framework comprising comfort, dignity, and the presence of loved ones, to guide ICU clinicians in withdrawing life-sustaining treatment. Results: The framework integrates established palliative principles into a cohesive and memorable tool for bedside decision-making, interdisciplinary practice, and trainee education. It enhances communication with families and promotes person-centred care. Conclusion: The Triad of dying provides a practical scaffold for reframing ICU death as a meaningful, human event rather than a medical failure. It fosters ethically grounded palliation that honours the values and identities of patients at life’s end.