Life-sustaining treatment may be ethically withdrawn or withheld in critically ill or dying newborns if the action is genuinely in the best interests of the patient. This may occur in situations where life-sustaining treatment is futile because of a hopeless prognosis, or if the burdens of intensive treatment clearly outweigh its likely benefits.
Can parents withdraw life-sustaining medical treatment from children with terminal conditions?
The dissenting opinion argued that the Texas law outlining when parents can withhold or withdraw life-sustaining medical treatment from a child with a certifiably terminal condition did not supercede their right to refuse.
When is Life-Sustaining Treatment ethically withdrawn in critically ill or dying newborns?
Life-sustaining treatment may be ethically withdrawn or withheld in critically ill or dying newborns if the action is genuinely in the best interests of the patient. This may occur in situations where life-sustaining treatment is futile because of a hopeless prognosis, or if the burdens of intensive treatment clearly outweigh its likely benefits.
When is it appropriate to withhold or withdraw life-sustaining treatment?
To withhold or withdraw life-sustaining treatment may be ethically appropriate when it is clear that this treatment will not benefit the child or adolescent. Such treatments include aggressive measures aimed at cure, resuscitation, mechanical ventilation, and so on.
When is it lawful to discontinue life-sustaining treatment?
The courts have accepted that where the withdrawal of life-sustaining treatment was in accordance with good medical practice and was appropriate in the clinical judgement of the doctors responsible for the patient’s care and best interests, it would be lawful to discontinue such treatment even though it would bring about the death of a patient (4).
When can you withdraw from life support?
The goal of withdrawing life support when death is expected is to remove treatments that are no longer desired or indicated and that do not provide comfort to the patient.
When can a surrogate withhold or withdraw a life sustaining treatment?
Explain that the surrogate should make decisions to withhold or withdraw life-sustaining interventions when the patient lacks decision-making capacity and there is a surrogate available and willing to make decisions on the patient's behalf, in keeping with ethics guidance for substituted judgment or best interests as ...
What is withdrawal of life sustaining treatment?
1. The goal of withdrawing life sustaining treatment is to remove treatments that are no longer desired or do not provide comfort to the patient. 2. The withholding of life-sustaining treatments is morally and legally equivalent to their withdrawal.
What is the difference between withdrawing and withholding life sustaining treatment?
Such decisions can essentially take one of two forms: withdrawing – the removal of a therapy that has been started in an attempt to sustain life but is not, or is no longer, effective – and withholding – the decision not to make further therapeutic interventions.
Which legally allows parents to withhold life sustaining treatment from a terminally ill child?
ADVANCE DIRECTIVES Those two legal documents are 1) a living will or 2) the durable power of attorney. A living will must be properly witnessed by a notary, and allows the patient to state, in writing, that they do not wish to be kept alive by artificial means or heroic measures.
Do patients have the right to refuse life sustaining treatment?
Under federal law, the Patient Self-Determination Act (PSDA) guarantees the right to refuse life sustaining treatment at the end of life.
Who decides to stop life support?
Typically, the person the patient designated as the medical power of attorney gets to decide whether life support should remain active or not. In the event that the patient has not designated medical power of attorney to anyone, the patient's closest relative or friend receives the responsibility.
Can a hospital remove life support without family consent?
Under existing law, a patient who has the capacity to decide may refuse any treatment, even if the result is certain death. Doctors cannot carry out treatment without a patient's consent, if the patient is able to give it.
When can I withdraw medical treatment?
In general, treatment is withdrawn when death is felt to be inevitable despite continued treatment. This would typically be when dysfunction in three or more organ systems persists or worsens despite active treatment or in cases such as multiple organ failure in patients with failed bone marrow transplantation.
Under what circumstances can treatment be stopped or feedings withdrawn?
When is it justifiable to discontinue life-sustaining treatments? If the patient has the ability to make decisions, fully understands the consequences of their decision, and states they no longer want a treatment, it is justifiable to withdraw the treatment.
Who makes decisions regarding withholding or withdrawing treatment?
The patient or decision maker, after being provided appropriate counseling and options, decides against this intervention to reflect personal values. Information from Education for Physicians on End-of-Life Care Trainer's Guide, Module 11, withholding, withdrawing therapy.
Why is life sustaining treatment futile?
This may occur in situations where life-sustaining treatment is futile because of a hopeless prognosis, or if the burdens of intensive treatment clearly outweigh its likely benefits.
Is there a difference between withholding resuscitation and withdrawing treatment?
There is no fundamental ethical difference between the withholding of resuscitation and the withdrawing of life-sustaining treatment once it has commenced. However the actions may have different emotional and psychological implications.
Should palliative care continue after life support is withdrawn?
Palliative care and symptomatic relief should always continue after life-support has been withdrawn . Emotional and practical support should be provided for parents and adequate training and support is essential for obstetric and neonatal unit staff.
The edge of viability
Infants being born too “early” is not a new phenomenon in the span of human history; the drive to save premature babies did not arise from any sense of duty or benevolence to protect or nurture the young.
Legal challenges
Doctors in the United Kingdom are well practised at navigating these legal and ethical hurdles, because cases have been coming before the English courts for more than 30 years.
Time for debate
With only two cases to date, and, within a year of each other, it’s too early to tell what decisions the courts will give in future life and death matters, and what reasoning judges will take into account.
When should a physician elicit patient goals of care?
Physicians should elicit patient goals of care and preferences regarding life-sustaining interventions early in the course of care, including the patient’s surrogate in that discussion whenever possible.
Is there an ethical difference between withholding and withdrawing treatment?
While there may be an emotional difference between not initiating an intervention at all and discontinuing it later in the course of care, there is no ethical difference between withholding and withdrawing treatment.
Is it ethical to withhold life sustaining interventions?
Decisions to withhold or withdraw life-sustaining interventions can be ethically and emotionally challenging to all involved. However, a patient who has decision-making capacity appropriate to the decision at hand has the right to decline any medical intervention or ask that an intervention be stopped, even when that decision is expected to lead ...
When can a child be treated as an adult?
Once a child reaches the age of 16, they are presumed in law (6) to be competent to give consent for themselves for their own surgical, medical or dental treatment, and any associated procedures, such as investigations, anaesthesia or nursing (7). Therefore the child should be treated as an adult.
What is brain dead child?
The “Brain Dead” child - (1) Where the criteria of brain - stem death are agreed by two practitioners (2). It is agreed within the profession that treatment is such circumstances is futile and the withdrawal of current medical treatment is appropriate;
What is the Children Act 1989?
The Children Act 1989 provides an overall statutory framework for the provision of children’s welfare and services but makes no specific provision concerning withholding or withdrawing treatment.
What happens if a local authority obtains a full care order?
If the local authority obtains a full care order, it gains Parental Responsibility and by virtue of the order, it is empowered to give consent to medical treatment matters on behalf of a child.
When was the RCPCH framework updated?
In 1997 the Royal College of Paediatrics and Child Health (RCPCH) produced a framework for practice in relation to withholding or withdrawing life saving treatment in children. This was subsequently updated in May 2004.
What is interim care order?
An interim care order has the same effect as a full care order, subject to the courts powers to make directions for assessment or for the duration of the order (17). This the approach endorsed in the matter of Re K (A Minor) (18), where it was held that in the case of a seriously ill child who was the subject of an ICO, the parents were not legally able, without the agreement of the local authority, to make a decision to consent to the withdrawal of the treatment. In this case a declaration was sought and obtained from the High Court that the treatment should be withheld.
When a child or young person falls within one of the 2 categories listed in section 5 above, and is admitted into
If a child or young person falls within one of the 2 categories listed in section 5 above, and is admitted into hospital with a life threatening condition, this protocol should be observed.
Principles
As endorsed by professional organizations in North America and Europe, ethical decision-making concerning providing or forgoing LSMT for children is guided by the patient’s best interests.
Process Guidance
The ethical duties of veracity and fidelity call physicians to share “complete, honest and unbiased information with patients and their families on an ongoing basis and in ways they find useful and affirming.” 17 Beneficent actions also include efforts to identify individuals, groups, and other resources that can provide support to the patient and family.
Special Situations
Medically administered nutrition and hydration constitute interventions that may be withheld or withdrawn for the same types of reasons as other medical treatments.
Recommendations
When decisions to forgo LSMT are being contemplated, compassionate care for children who are severely ill and their families is enhanced by attention to the following considerations:
Competing Interests
POTENTIAL CONFLICT OF INTEREST: Dr Christian provides medical-legal expert work in child abuse cases; and Drs Weise, Okun, and Carter have indicated they have no potential conflicts of interest to disclose.
Liaisons
Mary Lynn Dell, MD, DMin – American Academy of Child and Adolescent Psychiatry
Liaisons
Harriet MacMillan, MD, MSc, FRCPC – American Academy of Child and Adolescent Psychiatry