Institutional policies on determination of medically inappropriate interventions: use in five pediatric patients.
OBJECTIVE
To describe recent experience using the Texas Advance Directives Act to facilitate care of terminally ill children managed in the two tertiary pediatric hospitals of the Texas Medical Center, Houston, TX.


METHODS
Retrospective chart review.


METHODS
Two multidisciplinary pediatric intensive care units in Houston, TX.


METHODS
Five terminally ill children whose parents were unable to acquiesce to comfort or palliative care.


METHODS
Implementation of the Texas Advanced Directives Act of 1999.


RESULTS
Suspension of interventions thought to be medically inappropriate by the physicians of record in four of the five cases, with transfer of care in one instance.


CONCLUSIONS
Use of institutional policies in accordance with the Texas Advance Directives Act may assist in the care of terminally ill children and their families.
Okhuysen-Cawley
Regina
R
Critical Care Medicine and Medical Ethics Committee, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA. okhuysencawleyregina@uams.edu
McPherson
Mona L
ML
Jefferson
Larry S
LS
D002648:Child; D002675:Child, Preschool; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D016134:Organizational Policy; D010166:Palliative Care / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D019452:Terminally Ill / Q000331:legislation & jurisprudence*; D013781:Texas; D019564:Unnecessary Procedures; D028761:Withholding Treatment / Q000331:legislation & jurisprudence*