Ethical Issues and Considerations for Children with Critical Care Needs

Abstract

Pediatric critical care refers to the health care of children with life-threatening illness or following major surgery or severe injury. This care is offered in different contexts across the globe. In well-resourced environments, critical care may be provided in pediatric intensive care units (PICU), which provide highly complex medical care with advanced, potentially expensive technological devices aimed primarily at sustaining life; whereas in poorly resourced regions, only primary care may be available for critically ill or injured children. Even where PICU facilities are available, they are a scarce and expensive resource. The knowledge and ability to sustain a critically ill or injured child’s life, potentially with effects on the child and family’s quality of life and at the expense of other children’s health care, leads to frequent ethical challenges. Ethical issues related to how best to ensure optimal quality of life and the fair distribution of scarce resources are common. In-depth knowledge and understanding of the individual patient’s medical, scientific and psychosocial context, through interdisciplinary discussion and collaboration; as well as familiarity with the overriding, relevant ethico-legal policies and principles is essential for appropriate decision-making. Truthful communication with the family is essential, using a shared decision-making process, and the child’s best interest must be central to every decision. This chapter presents an overview of the recommended approach to, and important considerations for, ethical decision-making in the PICU, using a hypothetical case example.

“What every physician wants for every one of his patients old or young, is not just the absence of death but life with a vibrant quality”—(Elkinton 1966).