Withdrawal of care in the PICU: What happens if there is disagreement?

Most experienced pediatric intensivists, myself included, have encountered situations in which we, the doctors, believe continuing to support a child is unethical because it is not saving the life but prolonging the dying; whereas the child’s parents believe the opposite — that it is unethical to withdraw life support because all life is sacred, no matter the circumstances. Sometimes these situations arise because poor communication causes families to distrust the doctors. But sometimes both sides understand each other clearly, but still disagree profoundly about the proper thing to do. What happens then? Doctors often make the argument that we should not prolong suffering, and most people agree with that in my experience. Establishing if a patient is actually in pain can be difficult, and we virtually always have the means to relieve pain in these situations. More telling to me is the argument that families cannot compel physicians to act unethically, and futile care is unethical. (You can read an excellent piece about the history of this concept.) Yet even then, in theory, the physician can simply withdraw from the case, although from experience I can tell you it is difficult to find another physician to take on cases like this, and abandoning our patient without finding them another physician is clearly unethical (and illegal). All hospitals, particularly large ones with PICUs, have ethics committees in place to help in these situations. The goal is to bring in peo...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Critical Care Pediatrics Source Type: blogs