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Institutional policies on determination of medically inappropriate interventions: use in five pediatric patients

Regina Okhuysen-Cawley1, Mona L McPherson, Larry S Jefferson

  • 1Critical Care Medicine and Medical Ethics Committee, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA. okhuysencawleyregina@uams.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 10, 2007
PubMed

Insights

The Texas Advance Directives Act helped pediatric intensive care units manage terminally ill children when parents disagreed with comfort care. This law facilitated physician decisions on medically inappropriate interventions for end-of-life care.

Area of Science:

  • Pediatric critical care medicine
  • Bioethics
  • Palliative care

Background:

  • The Texas Advance Directives Act (TADA) provides a legal framework for end-of-life care decisions.
  • Disagreements regarding comfort or palliative care for terminally ill children can complicate medical management.
  • Tertiary pediatric hospitals face unique challenges in managing complex pediatric cases.

Observation:

  • A retrospective chart review examined the application of TADA in two Houston tertiary pediatric intensive care units.
  • The study focused on five terminally ill children whose parents could not agree with the proposed comfort or palliative care plan.
  • The Texas Advance Directives Act of 1999 was implemented to address these care conflicts.

Findings:

  • Physicians successfully suspended medically inappropriate interventions in four out of five cases.
  • In one case, care was transferred to another institution.
  • TADA facilitated the resolution of disagreements concerning life-sustaining treatments.

Implications:

  • Implementing institutional policies aligned with TADA can aid in managing end-of-life care for critically ill children.
  • The Act supports physicians in making difficult decisions when consensus with families is not reached.
  • This approach can help ensure patient-centered care aligned with medical judgment in pediatric intensive care settings.
Abstract

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