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Downar and colleagues worked with the Canadian Critical Care Society (CCCS) and the Canadian Association of Critical Care Nurses (CACCN) to develop and publish guidelines specific to the WLSM (Downar et al., 2016). They remarked that the guidelines were necessary given that despite the availability of published clinical recommendations, the process of WLSM varies considerably across ICUs and among clinicians globally (Downar, et al., 2016). Using a modified Delphi approach, the authors developed guidelines specific to four domains: preparing for withdrawal of life-sustaining measures, assessment of distress, pharmaceutical management of distress, and discontinuation of life-sustaining measures and monitoring. Due to the limitations of evidence to support particular practices, Downar et al. (2016) used the following grading system: We recommend was used for practices that are supported by multiple studies and were consistent with the countries legal and ethical framework; We suggest was used for practices supported by one study or expert opinion and is consistent with legal and ethical values.