title: Discontinuing treatment in children with chronic, critical illnesses.
abstract: Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the 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 mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.
authors.affiliation: Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Mahon
authors.forename: J A
authors.initials: JA
authors.lastname: Deatrick
authors.forename: H J
authors.initials: HJ
authors.lastname: McKnight
authors.forename: W K
authors.initials: WK
authors.lastname: Mohr
mesh_terms: D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy*; D003422:Critical Care; D003657:Decision Making; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D018447:Medical Futility; D009722:Nurse Practitioners; D012121:Respiration, Artificial