title: Limiting and rationing treatment in paediatric and neonatal intensive care.
abstract: In this chapter I consider the ethical decisions surrounding the provision and limitation of treatment offered to children requiring intensive care. I focus on the processes surrounding end of life decision making and consider how the concepts of futility, burden and uncertainty should impact upon these decisions. I also examine resource allocation to children's critical care services. The discussion does not provide a structure that will solve any given situation. It does take a practical approach to the issues faced by considering why we should engage in life limiting discussions; When they should occur; Who should be involved; How they should be carried out; and where and by what means withholding or withdrawal should occur. I have drawn the discussions closer to clinical practice with the intention of making them more useful, for those engaged in direct patient care, than those focused around philosophical principles.
authors.affiliation: Royal Manchester Children's Hospital, Pendlebury, Manchester M20 3FJ, UK. peter-marc.fortune@manchester.ac.uk
authors.forename: Peter-Marc
authors.initials: PM
authors.lastname: Fortune
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000941:ethics*; D003657:Decision Making; D026690:Ethics, Clinical; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000941:ethics; D015931:Intensive Care, Neonatal / Q000941:ethics; D008020:Life Support Care / Q000941:ethics*; D018447:Medical Futility / Q000941:ethics*; D011368:Professional-Family Relations; D040841:Resource Allocation / Q000941:ethics; D013727:Terminal Care / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*