Discontinuing treatment in children with chronic, critical illnesses

Decisions about optimal treatment for critically ill children are qualitati vely different from those related to adults. Technological advances over th e past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often techno logy dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are app lied and when technology should not be used or should be withdrawn. Much ha s been written about ethical decision making in the care of chronically, cr itically ill adults and newborns. In this article, relevant factors about t he care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a me chanism to explore these issues. Dimensions of futility, discontinuing aggr essive treatment, and a consideration of benefits and burdens are integrate d throughout the discussion to inform nurse practitioner practice. Copyrigh t (C) 2000 by W.B. Saunders Company.