title: Nurses as withdrawers of life sustaining treatment in paediatric intensive care.
abstract: BACKGROUND
  Withdrawal of life saving medical treatment is a common modality of death within UK paediatric intensive care units (PICUs). The majority of treatment withdrawals are carried out by medical staff, usually the consultant in charge of the child's care.
  
  
  OBJECTIVE
  To assess current practice of experienced PICU nurses performing the key tasks in treatment withdrawal once the decision has been made and its legal implications.
  
  
  METHODS
  The study was divided into three chronologically successive phases. In phase 1, a 12-item paper survey was circulated to nursing staff on a UK PICU. In phase 2, a three-item survey regarding current practice was sent to nurse managers on 22 UK PICUs. In phase 3, analysis of legal issues related to nurses withdrawing treatment was undertaken.
  
  
  RESULTS
  Poor response rates to both surveys limited their value; however, they may stimulate discussion of the issue within nursing. Phase 1 received 15 of 100 (15%) responses; open-ended questions highlighted practitioner concerns. Eight of twenty-two (36%) responses for phase 2 showed no consistent approach to the issue nationally. Legal analysis indicated that the law was untested in this area and nurses would be advised to withdraw treatment only if following a documented medical plan. Risks of legal and regulatory action could be reduced by formulating clear guidelines.
  
  
  CONCLUSIONS
  PICU nurses could potentially enact withdrawal, but discussion is needed to resolve uncertainties.
  
  
  CONCLUSIONS
  National Guidelines from within the PICU community could assist nurses participating in treatment withdrawal.
authors.affiliation: Centre for Ethics in Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol, UK. giles.birchley@bristol.ac.uk
authors.forename: Giles
authors.initials: G
authors.lastname: Birchley
authors.forename: Bev
authors.initials: B
authors.lastname: Cejer
mesh_terms: D001291:Attitude of Health Personnel; D004993:Ethics, Nursing; D006801:Humans; D015278:Intensive Care Units, Pediatric; D024802:Nurse's Role; D011795:Surveys and Questionnaires; D006113:United Kingdom; D028761:Withholding Treatment / Q000941:ethics* / Q000331:legislation & jurisprudence*