Abstract

SANTOS, Susana  and  ALMEIDA, Filipe. Withholding or withdrawing treatment decisions in pediatric intensive care units. Arq Med [online]. 2015, vol.29, n.3, pp.80-85. ISSN 2183-2447.

Withholding or withdrawing treatment decisions are becoming more and more common in pediatric intensive care units. This article pretends to review its ethical framework, define futile treatment, how the decision is made, the role and factors affecting both parents and physicians. This type of decision must be based on the bioethical principles, and always aims at child's best interest. it's impossible to define futility and in case of disagreement a due process approach should be followed. Proportionality of treatment, parents' and doctors' views are important for the decision. Parental involvement is variable. in Europe doctors usually take the decision whereas in North America parents do. Quality of life, suffering, cultural factors and medical facts influence greatly the parents. Probability of survival, chronic neurological disability, child's family and fear of litigation are important for doctors. These complex decisions have consequences in all engaged, so quality information is crucial. Health care institutions should adopt a policy on the matter and more ethics education is needed.

Keywords : pediatric death; intensive care; ethics; futility.

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