title: Parental Refusal of Surgery in an Infant With Tricuspid Atresia.
abstract: We present a case of a fetal diagnosis of tricuspid atresia (TA). The pregnant woman and her husband requested that the baby be treated with only palliative care. The cardiologist did not think it would be appropriate to withhold life-prolonging surgery once the infant was born. The neonatologist argued that outcomes for TA are similar to those for hypoplastic left heart syndrome, and the standard practice at the institution was to allow parents to choose surgery or end-of-life care for those infants. The team requested an ethics consultation to assist in determining whether forgoing life-prolonging interventions in this case would be ethically supportable. In this article, we ask a pediatric intensivist, a pediatric cardiologist, and a neonatologist to discuss the ethics of withholding life-sustaining treatment of a baby with TA.
authors.affiliation: Naval Medical Center San Diego and the University of California San Diego School of Medicine, San Diego, California.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Kon
authors.affiliation: Lurie Children's Hospital, Chicago, Illinois.
authors.forename: Angira
authors.initials: A
authors.lastname: Patel
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin; and.
authors.forename: Steven
authors.initials: S
authors.lastname: Leuthner
authors.affiliation: Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri jlantos@cmh.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Lantos
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D003657:Decision Making; D005260:Female; D005865:Gestational Age; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016312:Treatment Refusal / Q000941:ethics*; D018785:Tricuspid Atresia / Q000000981:diagnostic imaging* / Q000601:surgery; D016216:Ultrasonography, Prenatal / Q000379:methods*; D028761:Withholding Treatment / Q000941:ethics*; D055815:Young Adult