Withholding and withdrawal of Medical treatment decisions from Case Study

Withholding and withdrawal of Medical treatment decisions from Children and neonates - Case Study Example Parents, doctors, the health care team have a common goal in ensuring good health and sustaining the life of children and neonates. Although advanced technology makes it possible to prolong life, prolonging life beyond a meaningful point in some neonatal and children's cases involves making difficult decisions on when and how life sustaining treatment is to be withheld or withdrawn. The Ethics Advisory Committee of the Royal College of Pediatrics and Child Health (EAC - RCPCH) has defined five categories in which the withholding or withdrawal of life sustaining medical treatment can be done.With holding or withdrawing does not even mean that the child will receive no care. Such a decision is followed by palliative care for the child. The withholding and withdrawing decisions is made by only experienced senior doctors. Clinical situations of these decisions include Non-resuscitation of a baby at birth with congenital abnormalities like anencephaly, making the child incompatible for su rvival; Non- resuscitation of a baby born with a gestational period of twenty three weeks or less making the baby neurologically impaired; withdrawal of ventilation from the baby with birth asphyxia leading to brain damage.The frequency of selective non treatment of extremely premature, critically or mal formed infants in Level III intensive care nursery (ICU) and the reasons documented by neonatologists for their decisions to withdraw or with hold life support has been well documented (Wall, 1997). They reviewed all the medical records of 165 infants who died at a level III (ICN) during 3 years. One hundred and eight infant deaths were found to be due to withdrawal of life support and thirteen deaths due to withhold of treatment. End of life decisions in new born with incurable diseases are difficult for pediatricians. In Netherlands, deliberate ending of life can be acceptable choice if a life full of severe and sustained suffering that cannot be relieved by any other means is expected of the child (Verhagen 2005). During a study for the period from January 1988 through December 1991, of 529 neonates admitted in Sophia Children's Hospital, Rotterdam, the Netherlands, 524 had been found dead of which 28 were due to the disease and 24 cases due to withdrawn or withheld treatment. In 15 of the 24, treatment was withdrawn due to severe congenital anomalies; in 9 of the 24, treatment was withdrawn because of serious complications. But in all the cases withdrawal was done unanimously after lengthy discussions between doctors, nurses and the parents (Hazebroek, 1993). Withdrawal of treatment in pediatric intensive care units accounts for between 43% and 72% of deaths in U.K (Mcmillan 2000). The Law:- All such professional decisions are done within the framework of law. The children Act (England and Wales 1989) safeguard the children's welfare. The Act also introduces the concept of parental responsibility. A number of judgments on withholding or withdrawing life sustaining treatment have proved that there is no obligation on part of the doctors to give treatment which is futile and burdensome and such a treatment could be treated as an assault. They have also given enough scope for the treatment goals to be changed in case of a dying child. These judgments have legalized the withdrawal of feeding and medical treatment In such cases in the best interests of the children. Withdrawal of life sustaining treatment in appropriate cases is not active killing, nor does it breach the article 2 of the European Convention on Human Rights. Decision Making: Initially the medical team must wait for enough information about the clinical status of the child. The decision making process involves all members of the Health Care Team and the parents. In practice, a decision to withdraw treatment is usually a matter of consensus. However such major decisions always require a second opinion, legal as well as clinical.