[A "good" death in pediatric ICU: is it possible?].
OBJECTIVE
In the modern pediatric intensive care unit (PICU) physicians are often faced with the need to interrupt life-sustaining treatment (LST) and to allow children to die when no further treatment options are available. Consequently, the importance of palliative care has been increasing in this context. The goal of this review is to provide intensivists with guidelines to allow PICU patients to have a more dignified and humane death.


METHODS
Medline was searched using relevant key-words, emphasizing the topic of death in the PICU. The principles of palliative care medicine were then applied to this context.


RESULTS
To ensure a dignified death for a child receiving palliative care in the PICU some important measures must be taken, such as: let the family participate in the decision-making process in an open and honest manner; allow family members to perform their religious rites and rituals; offer them moments of complete privacy; effectively manage pain and discomfort, especially at the time of removal of LST; and finally, let the family be present when LST is interrupted, if they so desire.


CONCLUSIONS
A child's death following withdrawal of LST in the PICU can be humane and dignified if basic principles of palliative care are followed. This is especially important in an environment that is notorious for the use of complex technology and described by the general public as inhumane.
Garros
Daniel
D
Universidade de Alberta, Edmonton, Alberta, Canada. dgarros@cha.ab.ca
D002648:Child; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000941:ethics*; D008020:Life Support Care / Q000941:ethics / Q000523:psychology; D011368:Professional-Family Relations / Q000941:ethics; D012297:Right to Die; D013727:Terminal Care / Q000941:ethics* / Q000523:psychology