Children with cancer: special considerations in the discontinuation of life-sustaining treatment.
Every year in the United States, over 2,100 children die of progressive cancer, or of complications related to the disease or its treatment. Physicians, other clinicians, and parents caring for these children are often faced with decisions about the continuation or termination of life-sustaining treatment (LST). In adults, a consensus has emerged which holds that LST may be ethically discontinued if the burdens of continued treatment outweigh its benefits for the patient. While this standard is also applicable to LST decisions in pediatric oncology, its appropriate use must address several medical and ethical issues characteristic of children with cancer. These special considerations, which are the subject of this discussion, include the extensive medical experience of children with cancer, the nature of modern oncology treatment, the unpredictable patterns of response to treatment, the parent and/or physician biases which may threaten the child's well-being, the distinction between being incurably ill and imminently dying, the need for effective palliative care, and the variable levels of cognitive and emotional development which determine a child's capacity for participating in an LST decision. Consideration of these factors facilitates a consistent approach to these difficult decisions which is both compatible with current ethical guidelines and responsive to the particular needs of these patients.
Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
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Freyer
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D032882:Comprehension; D004992:Ethics, Medical; D005066:Euthanasia, Passive / Q000639:trends; D006801:Humans; D007223:Infant; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D010344:Patient Advocacy; D026684:Personal Autonomy; D012297:Right to Die; D018570:Risk Assessment; D028761:Withholding Treatment