The nature of paediatric intensive care medicine is such that when the battle with a disease process cannot be won, focus needs to be placed on achieving a dignified death. If the situation permits, families will often opt for a peaceful passing away in familiar surroundings, at home or in a hospice. We focus on the common practical considerations that need to be addressed in order to facilitate the return home; as well the necessary planning to conform to legal requirements following a child’s expected death outside the hospital setting.

We look into what medications might be needed for symptom control and what the challenges of prescribing these in the community might be. We shall also look into the importance of assessing the home environment and social support in advance, as well as what the logistics of transporting the patient out of hospital are. Furthermore we touch upon who needs to be involved in the on-going medical care of the child, as well as possible contingency plans, should the child survive at home.

Finally we shall explore what the role of the intensive care physician is in facilitating what is required by law; including confirmation of death, discussions with the coroner, and transport to the mortuary. Good, advance planning enables clinicians to minimise the invasion of the family’s privacy during these delicate moments, and helps make a child’s death as dignified as possible.