Tracy K. Koogler

Parental Views on Withdrawing Life-Sustaining Therapies in Critically Ill Children

OBJECTIVE To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies. DESIGN Quantitative and qualitative analysis of semi-structured one-on-one interviews. SETTING The PICUs at 2 tertiary care hospitals. PARTICIPANTS English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week. INTERVENTION Semi-structured one-on-one interviews. RESULTS Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition. CONCLUSION Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.

Ethical issues in the care of the neurologically devastated infant.

The debate surrounding neurologically devastated newborns, whether due to severe prematurity or genetic malformations, has continued for over 40 years. Duff and Campbell (1973) first discussed allowing these children to die in the 1970s. In the 1980s, others fought to make sure these children with disabilities were afforded all the rights of other children. Recently, some commentators have advocated for withdrawal of therapies and even euthanasia in the Netherlands. Who is right? What are the ethical principles that should be followed? What decisions are appropriate for distraught parents to make? This chapter reviews international views, laws, and guidelines surrounding the therapies and limitations of care for these imperiled newborns. An ethical argument is presented for how to determine best interests for these special children utilizing the best interest standard. Parents and physicians need to use their individual expertise and values to work together to determine each individual childs best interests. Physicians may have to carry the burden for making final determinations to alleviate the guilt families may have in deciding to limit therapies.

Triage ethics not individual choice

In this issue, Kukora and Laventhal(1) propose prohibiting adults who refuse the influenza vaccine from receiving Extra Corporeal Membrane Oxygenation (ECMO) for overwhelming influenza during a pandemic when ECMO becomes a scare resource. They argue if one autonomously decides to forego vaccination, then a just consequence is not receiving ECMO if one becomes critically ill. The authors equate this to requiring alcoholics to be sober prior to a liver transplant. Unfortunately, the situation is more similar to the drunk driver after an accident that requires life-saving therapies. We provide critical therapies in an attempt to save the life regardless of why they are dying. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en