Limitation of therapeutic effort in Paediatric Intensive Care Units: Bioethical knowledge and attitudes of the medical profession

Abstract

Paediatric intensive care is a relatively new specialty, with significant technological advances that lead to the prolongation of the dying process. One of the most common bioethical problems is limitation of treatment, which is the adequacy and/or proportionality treatment, trying to avoid obstinacy and futility.

Objective: To determine the experience of physicians working in Paediatric Intensive Care Units (PICU) when faced with bioethical decisions.

Subjects and Method: An observational, descriptive and cross-sectional study was conducted using an anonymous questionnaire sent to physicians working in PICU. The data requested was related to potential ethical problems generated in the care of the critical child, and the procedure for their resolution. The study was approved by the Ethics Research Committee of the Faculty of Medicine UDD CAS.

Results: A total of 126 completed questionnaires were received from physicians working in 34 PICU in Chile. Almost all (98.41%) of them acknowledged having taken therapeutic limitation decisions (TLD). The most common type of TLD mentioned was the Do Not Resuscitate order (n = 119), followed by the establishment of no medications (n = 113), limited admission to PICU (n = 81), with the withdrawal of treatment being the least mentioned (n = 81). Around one-third (34.13%) felt that there were no ethical difference between introducing or removing certain treatments.

Conclusions: Bioethical dilemmas are common in the PICU, with therapeutic limitation decisions being frequent. Many recognise not having expertise in clinical ethics, and they need continuing education in bioethics.