Year: 2024
Type: article
Abstract: Decisions to initiate long-term ventilation (LTV) in children with severe neurologic impairment have recently been subject to candidacy determinations by home ventilation teams that exclude patients based on their neurologic status alone. Determinations of whether decisions are inappropriate require careful analysis of specific clinical circumstances and attention to the family's values. In this Ethics Rounds, we present a case of a previously healthy child who sustained an acute severe anoxic brain injury and was assessed by the medical team to have a high likelihood of remaining minimally conscious or unconscious. It was determined that he was not a candidate for LTV based on the severity of neurologic impairment. The family disagreed and declined withdrawal of ventilatory support. Drawing upon our backgrounds in intensive care, pulmonology, and bioethics, we offer commentary on utilizing a candidacy-based approach for LTV decisions in children with severe neurologic impairment from variable perspectives, including clinical determinations of inappropriate care, ablest biases and discrimination, and obligations to maintain a just process.
Source: PEDIATRICS
Institutions: University of Washington, Seattle Children's Research Institute, Treuman Katz Center for Pediatric Bioethics and Palliative Care, Cincinnati Children's Hospital Medical Center, University of Cincinnati, University of Minnesota, Louisiana State University, Children's Hospital of New Orleans, Louisiana State University Health Sciences Center New Orleans
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Award: G3853883368
OpenAlex ID: W4404118029