[Limitation of the therapeutic effort in pediatric intensive care]

Area of Science:

• Pediatric Intensive Care Medicine
• Medical Ethics
• Bioethics

Background:

• Pediatric intensive care (PICU) has advanced technologically, leading to prolonged dying processes and increased patient/family suffering.
• The concept of 'limitation of therapeutic effort' addresses treatment adequacy and proportionality to avoid medical futility.
• English literature uses 'withholding or withdrawal of life-sustaining treatment' instead of 'limitation of treatments'.

Purpose of the Study:

• To review the current knowledge on limiting therapeutic efforts in pediatric clinical practice.
• To highlight the ethical challenges in end-of-life care within PICU.
• To emphasize the need for improved bioethics education for PICU physicians.

Main Methods:

• Literature review of current knowledge on therapeutic limitation in PICU.
• Analysis of terminology used in English literature regarding end-of-life care.
• Examination of the role of bioethics in PICU decision-making.

Main Results:

• Common methods of limiting treatment include withholding/withdrawing life support and not performing cardiopulmonary resuscitation (CPR).
• There is a noted deficiency in medical training regarding bioethics among PICU physicians.
• Decisions regarding end-of-life care are often made without bioethicist consultation.

Conclusions:

• Limiting therapeutic efforts is a critical aspect of pediatric intensive care, aiming to prevent burdensome treatments.
• Improved bioethics training and consultation are essential for navigating complex end-of-life decisions in the PICU.
• Standardizing terminology and practices for limiting life-sustaining treatment is necessary.