Continuation of Potentially Inappropriate Life-Sustaining Therapies: Provider Perspectives.

Area of Science:

• Pediatric Critical Care Medicine
• Medical Ethics
• Bioethics

Background:

• Limited data exist on physician approaches when considering withholding or withdrawing life-sustaining therapies against family wishes.
• Prior research focused on provider perspectives when overriding family objections to withholding treatment.

Purpose of the Study:

• To understand how pediatric critical care clinicians navigate situations where families request potentially inappropriate life-sustaining therapies.
• To explore physician decision-making processes in complex end-of-life care scenarios involving pediatric patients.

Main Methods:

• Semi-structured group interviews with pediatric critical care faculty.
• Development of a national, case-based ethical dilemma survey for pediatric intensivists.
• Analysis of responses to a specific survey question regarding continued support after severe traumatic brain injury.

Main Results:

• Most participants indicated they would offer requested interventions, but significant variation existed in subsequent actions.
• Physicians aimed to balance avoiding prolonged suffering with respecting parental decision-making roles.
• Responses to a case involving a child with severe traumatic brain injury and poor prognosis revealed diverse approaches.

Conclusions:

• The variability in physician approaches highlights the complexity of these ethical dilemmas.
• Institutional support structures (ethics, legal, risk management, palliative care) are crucial.
• There is a need for enhanced training, practice, and institutional support for physicians managing these challenging family-centered decisions.