[Decision-making regarding life-sustaining medical treatment in a pediatric intensive-care unit]

The complexity of the decision-making process regarding life-sustaining medical treatment was illustrated by the single case of a 12-year-old boy with severe meningococcal septicaemia. When his clinical condition deteriorated, necessitating haemodialysis and multiple amputations of the extremities, questions about the futility of treatment and the future quality of life puzzled the attending physician. In consultation with the treatment team and the parents, it was decided to continue medical treatment in this patient since there was too little prognostic certainty concerning bodily functions and morbidity and the expected future quality of life. After 60 days, the patient was discharged. Half-a-year later he was following an intensive rehabilitation programme and the possibility of renal transplantation was contemplated. Because of the consequences for the child and his family, a decision to continue life-sustaining medical treatment should be justified as thoroughly as one to withdraw or withhold treatment.