Ethics: end-of-life decision-making in a pediatric patient with SMA type 2: the influence of the media.
OBJECTIVE
Spinal muscular atrophy (SMA) is a group of progressive and fatal neurodegenerative disorders that are characterized by destruction of the anterior horn cells of the spinal cord. In this case report we outline the medical and ethical issues involved in a 7-year-old boy with SMA type 2 who experienced acute respiratory failure.


METHODS
A review of the literature was conducted focusing particularly on the pathology, presentation, and outcomes of SMA and end-of-life decision-making in pediatrics.


RESULTS
In a world where 40%-60% of deaths in pediatric intensive care units are a result of withdrawal or limitation of life-sustaining treatment, end-of-life decision-making has become an integral and difficult part of pediatric practice.


CONCLUSIONS
Limitation or withdrawal of life-sustaining treatment in a cognitively normal child with SMA poses a significant medical and ethical dilemma. This difficult decision is influenced by confluence of parental, doctor, social, cultural, moral, religious, legal, and economic factors and more recently the media.
The Hospital for Sick Children, University of Toronto, Canada. madelinejdrake@gmail.com
Madeline
M
Drake
Peter
P
Cox
D002648:Child; D003146:Communications Media / Q000941:ethics*; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000941:ethics*; D014897:Spinal Muscular Atrophies of Childhood / Q000191:economics / Q000503:physiopathology* / Q000523:psychology; D013727:Terminal Care / Q000941:ethics*