title: [Limitation of therapeutic effort in Paediatric Intensive Care Units: Bioethical knowledge and attitudes of the medical profession].
abstract: Paediatric intensive care is a relatively new specialty, with significant technological advances that lead to the prolongation of the dying process. One of the most common bioethical problems is limitation of treatment, which is the adequacy and/or proportionality treatment, trying to avoid obstinacy and futility.
  
  
  OBJECTIVE
  To determine the experience of physicians working in Paediatric Intensive Care Units (PICU) when faced with bioethical decisions.
  
  
  METHODS
  An observational, descriptive and cross-sectional study was conducted using an anonymous questionnaire sent to physicians working in PICU. The data requested was related to potential ethical problems generated in the care of the critical child, and the procedure for their resolution. The study was approved by the Ethics Research Committee of the Faculty of Medicine UDD CAS.
  
  
  RESULTS
  A total of 126 completed questionnaires were received from physicians working in 34 PICU in Chile. Almost all (98.41%) of them acknowledged having taken therapeutic limitation decisions (TLD). The most common type of TLD mentioned was the Do Not Resuscitate order (n=119), followed by the establishment of no medications (n=113), limited admission to PICU (n=81), with the withdrawal of treatment being the least mentioned (n=81). Around one-third (34.13%) felt that there were no ethical difference between introducing or removing certain treatments.
  
  
  CONCLUSIONS
  Bioethical dilemmas are common in the PICU, with therapeutic limitation decisions being frequent. Many recognise not having expertise in clinical ethics, and they need continuing education in bioethics.
authors.affiliation: Programa de Magíster en Bioética, Clínica Alemana-Universidad del Desarrollo, Chile; Unidad de Cuidados Intensivos Pediátricos, Hospital Roberto del Río, Chile; Profesor Agregado, Facultad de Medicina, Universidad de Chile, Chile. Electronic address: gomoralesv@udd.cl.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Morales Valdés
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Roberto del Río, Chile.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Alvarado Romero
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Luis Calvo Mackenna, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Zuleta Castro
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D026688:Bioethical Issues; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000941:ethics; D010820:Physicians / Q000941:ethics; D016414:Resuscitation Orders / Q000941:ethics; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*
keywords: Bioethics; Bioética; Cuidado intensivo; Intensive care; Limitación de esfuerzo terapéutico; No-aplicación; Paediatrics; Pediatría; Withdrawal of life-sustaining treatment; Withholding