title: Mechanical ventilation for a child with quadriplegia.
abstract: Parents generally have the right to make medical decisions for their children. This right can be challenged when the parents' decision seems to go against the child's interests. The toughest such decisions are for a child who will survive with physical and neurocognitive impairments. We discuss a case of a 5-year-old boy who suffered a spinal injury as a result of a motor vehicle accident and whose father requests discontinuation of life support. Many experts recommend a "trial of therapy" to clarify both prognosis and quality of life. The key ethical question, then, is not whether to postpone a decision to forego mechanical ventilation. Instead, the key question is how long to wait. Parents should be allowed time to see what life will be like for themselves and for their child. Most of the time, life turns out better than they might have imagined. Comments are provided by 2 pediatric intensivists, Drs William Novotny and Ronald Perkin of East Carolina University, and by a specialist in rehabilitation, Dr Debjani Mukherjee of the Rehabilitation Institute of Chicago.
authors.affiliation: Department of Pediatrics, East Carolina University, Greenville, North Carolina;
authors.forename: William E
authors.initials: WE
authors.lastname: Novotny
authors.affiliation: Department of Pediatrics, East Carolina University, Greenville, North Carolina;
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Perkin
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois; Donnelley Ethics Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and.
authors.forename: Debjani
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: University of Missouri at Kansas City and Children's Mercy Hospital, Kansas City, Missouri jlantos@cmh.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Lantos
mesh_terms: D002675:Child, Preschool; D006801:Humans; D008297:Male; D011782:Quadriplegia / Q000523:psychology / Q000628:therapy*; D012121:Respiration, Artificial / Q000941:ethics* / Q000523:psychology; D013727:Terminal Care / Q000941:ethics* / Q000523:psychology
keywords: child; decisional capacity; ethics; quadriplegia; quality of life; right to refuse treatment; substituted judgment