It is important that physicians give proper care to terminally ill patients; they require appropriate and early recognition of their needs (also through the use of standardized and validated tools) thus leading to correct management of symptoms (such as pain, dyspnea, agitation, respiratory secretions), the remodulation of pharmacological therapy, adequate communication and advance and shared planning of care, as well as attention to his/her multidimensional needs. Potentially futile procedures and therapies in this context may be: antibiotic therapy (not indicated in cases in which symptomatic improvement is not expected from its administration and inappropriate in situations in which the risks of adverse events exceed the expected benefits); blood transfusions (recommended only for Hb values < 7 g/dl and in the presence of severe symptoms, or < 8 g/dl in the presence of active bleeding or acute coronary syndrome; prophylactic platelet transfusions are not indicated if above 10,000/mm3 and in the absence of moderate-severe bleeding); anticoagulant therapy (indicated only if it can relieve symptoms such as dyspnoea, chest pain and tense edema of a limb and in any case to be suspended in the pre-agonistic phase); Non-invasive ventilation (useful only if it improves dyspnea and not indicated if it worsens the quality of the end of life or communication; the difficulty of suspending it once started must also be carefully considered).

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