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Ethical issues in managed and rationed care for children with severe neurological disabilities: a questionnaire
Insights
Pediatric neurosurgeons believe children with severe neurological disabilities deserve equal medical care. However, they feel some interventions, like cardiopulmonary resuscitation (CPR), may not be indicated if retrieval is unlikely, and cost should influence care decisions.
Area of Science:
- Pediatric Neurosurgery
- Medical Ethics
- Healthcare Management
Background:
- Children with severe neurological disabilities often require complex medical care.
- The ethical considerations and resource allocation for this patient population are subjects of ongoing debate.
Purpose of the Study:
- To survey pediatric neurosurgeons' attitudes towards managed and rationed care for children with severe neurological disabilities.
- To compare the views of International Society of Pediatric Neurosurgery (ISPN) members with those of the Child Neurology Society (CNS).
Main Methods:
- A questionnaire was distributed to 399 members of the ISPN.
- 156 ISPN members (39.1%) responded to the 15-question survey.
- Responses were compared with those from CNS members.
Main Results:
- Most respondents agreed that children with severe neurological disabilities should receive the same medical care as typically developing children.
- A majority felt cardiopulmonary resuscitation (CPR) is not indicated if a child is not retrievable.
- Most respondents believed that the cost of care should influence its provision.
Conclusions:
- Pediatric neurosurgeons generally support equitable medical care for children with severe neurological disabilities.
- There is a nuanced view regarding the indication of specific interventions like CPR based on prognosis.
- Cost is considered a factor in the management and rationing of care for these children.
Abstract:
The attitudes of pediatric neurosurgeons to managed and rationed care for children with severe al neurological disabilities were surveyed as reflected in responses from International Society for Pediatric Neurosurgery (ISPN) members to a questionnaire. Of 399 ISPN members, 156 (39.1%) responded to the questionnaire. There were 15 questions, which were designed to explore what care is medically indicated, whether all medically indicated care should always be provided, and how this care should be managed or rationed. Most respondents agreed that these patients should receive the same level of medical care as a normally developing child. However, respondents felt that cardiopulmonary resuscitation (CPR) is not indicated if a child is not retrievable. Most respondents also felt that provision of care should be influenced by cost. The responses to the questions from ISPN members were compared with those from Child Neurology Society (CNS) members.