title: Institutional policies on determination of medically inappropriate interventions: use in five pediatric patients.
abstract: 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.
authors.affiliation: 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
authors.forename: Regina
authors.initials: R
authors.lastname: Okhuysen-Cawley
authors.forename: Mona L
authors.initials: ML
authors.lastname: McPherson
authors.forename: Larry S
authors.initials: LS
authors.lastname: Jefferson
mesh_terms: 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*