title: The decision making process regarding the withdrawal or withholding of potential life-saving treatments in a children's hospital.
abstract: OBJECTIVE
  To investigate the factors considered by staff, and the practicalities involved in the decision making process regarding the withdrawal or withholding of potential life-sustaining treatment in a children's hospital. To compare our current practice with that recommended by the Royal College of Paediatrics and Child Health (RCPCH) guidelines, published in 1997.
  
  
  METHODS
  A prospective, observational study using self-reported questionnaires.
  
  
  METHODS
  Tertiary paediatric hospital.
  
  
  METHODS
  Consecutive patients identified during a six-month period, about whom a formal discussion took place between medical staff, nursing staff and family regarding the withholding or withdrawal of potentially life-sustaining treatments. The primary physician and primary nurse involved in the discussion were identified.
  
  
  METHODS
  Two questionnaires completed independently by the primary physician and nurse.
  
  
  RESULTS
  Twenty-two patients were identified (median age 1 year; range 1 day-34 years). In 20 cases treatment was withdrawn or withheld, in two cases treatment was continued. Nursing staff considered family wishes and family perceptions of patient suffering as significantly more important factors in decision making than medical staff, who considered prognostic factors as most important. In only two cases were the patient's expressed wishes apparently available. In most cases staff considered the patient's best interests were served and the process would not be enhanced by the involvement of an independent ethics committee. The exceptions were those cases in which treatment was continued following disagreement between parties.
  
  
  CONCLUSIONS
  Our current practice is consistent with that recommended by the RCPCH. The contribution of the patient, provision of staff counselling and general practitioner (GP) involvement were identified as areas for improvement.
authors.affiliation: University of Bristol. karen_street_khan@yahoo.co.uk
authors.forename: K
authors.initials: K
authors.lastname: Street
authors.forename: R
authors.initials: R
authors.lastname: Ashcroft
authors.forename: J
authors.initials: J
authors.lastname: Henderson
authors.forename: A V
authors.initials: AV
authors.lastname: Campbell
mesh_terms: D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D034462:Dissent and Disputes; D004739:England; D005066:Euthanasia, Passive; D005190:Family; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D008020:Life Support Care / Q000592:standards*; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D016134:Organizational Policy; D033282:Parental Consent; D011368:Professional-Family Relations; D011446:Prospective Studies; D011795:Surveys and Questionnaires