Intensivists are increasingly implementing end-of-life decisions in patients who remain dependent on life sustaining therapies without hope for recovery. Descriptive studies have provided epidemiological data on ICU end-of-life care, identifying areas for improvement. Qualitative studies have highlighted the complexity of the decision making process. In addition to considering the legal and ethical issues involved, this review describes cultural, religious and individual variations observed in ICU end-of-life care. It is important for intensivists to respect patients' preferences and values, but also, in some family members, to avoid increasing the burden and the guilt of sharing the decision. Intensivists should improve their ability to meet the needs of dying patients and their family members. Each situation, patient, family and caregiver is unique, and therefore needs a specific approach. Introducing palliative care and multidisciplinary teams into the ICU might provide an additional opportunity for patients and families to be informed and listened to.