Withdrawal of medical treatment in children

MTP After 20 weeks: When & How?

Medical Termination of pregnancy is a common gynaecological procedure. Unlike other procedures, this procedure has ethical, moral and legal overtones. Medical termination of pregnancy is governed strictly by the Medical Termination of pregnancy Act (MTP Act). The law allows termination of pregnancy [TOP] for "certain" indications and only until "certain" weeks of pregnancy. This poses serious dilemma in front of the gynaecologist. Judicial activism by the author paved way to significant relaxations and amendment to the law. These amendments, when applicable, will enable women and their care givers to undergo legal termination of pregnancy even after twenty weeks in certain situations. The MTP Act has been amended in 2021 by the parliament. After the rules and regulations are amended, it is likely to get applicable soon. The new law has resolved few dilemmas and created new ethical and legal issues.

Parental views on withdrawing life-sustaining therapies in critically ill children

OBJECTIVE

To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies.

DESIGN

Quantitative and qualitative analysis of semi-structured one-on-one interviews.

SETTING

The PICUs at 2 tertiary care hospitals.

PARTICIPANTS

English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week.

INTERVENTION

Semi-structured one-on-one interviews.

RESULTS

Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition.

CONCLUSION

Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.