Guidance for Healthcare Ethics Committees: Ethical issues in pediatrics
2012
Objectives Identify ethical difficulties in the role of parental decision-making. Discuss pediatric assent and the ability to consent for themselves. Recognize the diiculty with applying the “best interest” standard for some
children. Case 1 Tommy, 3, sustained a traumatic brain injury (TBI) from a motor vehicle accident. Two weeks
into his ICU stay, physicians presented Tommy’s parents with the option to forgo life-sustaining
treatments (FLST). After a few days of reflecting and discussing the issue, they agreed that stopping
the ventilator was best, but by that time there was a new ICU physician who, after review of
Tommy’s condition, did not think that FLST was warranted. With more intensive therapy, Tommy
was able to breathe without the vent, and he was moved to the rehabilitation unit. Because of
his TBI, however, he continued to be fed through a tube. Neurological scans indicated problems
with the basal ganglia, and Tommy’s parents suggested that Tommy’s condition was not in his
best interest and asked the palliative care physician about the possibility of stopping feeds. At
the same time, the physical and occupational therapists working with Tommy, as well as nurses
and social workers from the PICU who came to visit him in rehab, believed they saw slight but
noticeable improvements in his cognitive status – possibly tracking, smiling, and reacting to
some stimuli. The entire unit, as well as these PICU staff members, is concerned about the ethics
of what the parents are suggesting.
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