At the coalface--medical ethics in practice. Futility and death in paediatric medical intensive care.
We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care.
Balfour-Lynn
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Great Ormond Street Hospital for Children NHS Trust, London.
Tasker
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004739:England; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D015931:Intensive Care, Neonatal; D008020:Life Support Care; D008131:London; D008297:Male; D018447:Medical Futility; D012189:Retrospective Studies; D017211:Treatment Failure; D028761:Withholding Treatment