title: Update on Ethical Issues in Pediatric Dialysis: Has Pediatric Dialysis Become Morally Obligatory?
abstract: Improvements in pediatric dialysis over the past 50 years have made the decision to proceed with dialysis straightforward for the majority of pediatric patients. For certain groups, however, such as children with multiple comorbid conditions, children and families with few social and economic resources, and neonates and infants, the decision of whether to proceed with dialysis remains much more controversial. In this review, we will examine the best available data regarding the outcomes of dialysis in these populations and analyze the important ethical considerations that should guide decisions regarding dialysis for these patients. We conclude that providers must continue to follow a nuanced and individualized approach in decision making for each child and to recognize that, regardless of the decision reached about dialysis, there is a continued duty to care for patients and families to maximize the remaining quality of their lives.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.|Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Aaron G
authors.initials: AG
authors.lastname: Wightman
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Freeman
mesh_terms: D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000941:ethics; D015897:Comorbidity; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000628:therapy*; D028681:Moral Obligations; D006435:Renal Dialysis / Q000941:ethics*; D012959:Socioeconomic Factors; D028761:Withholding Treatment / Q000941:ethics
keywords: Child; Decision Making; Economic Impact; Humans; Moral Obligations; dialysis withholding; mortality; pediatric nephrology; pediatrics; renal dialysis