Withdrawal of life sustaining treatment in children in the first year of life
Objective: Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe...
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| Veröffentlicht in: | Journal of Perinatology 2008-09, Vol.28 (9), p.641-645 |
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| container_title | Journal of Perinatology |
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| creator | Eason, E B Castriotta, R J Gremillion, V Sparks, J W |
| description | Objective:
Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process.
Study Design:
A single reviewer retrospectively reviewed the cases for patient diagnoses, demographics, related ethical issues and the actions of the MARC.
Result:
Each of the six patients required life-sustaining therapy, and each patient had a Do Not Resuscitate order on the chart. The MARC determined that it would be appropriate to withdraw life-sustaining support in four of the cases and to continue support in two of the cases. Five of the patients died in the hospital before discharge: two after discontinuation of support, one during the 10-day waiting period, and two died on full support after the Committee determined that continued treatment was medically appropriate. One patient was transferred to another hospital during the 10-day waiting period.
Conclusion:
These cases document the application of the TADA/MARC process in infants, even in circumstances where care was withdrawn without concurrence of the family. We found the MARC process to demand a very high degree of certainty of diagnosis and prognosis to determine continuation of care to be inappropriate. We conclude that the MARC promoted communication and provided additional protections to patients, families, physicians and staff. |
| doi_str_mv | 10.1038/jp.2008.58 |
| format | Article |
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Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process.
Study Design:
A single reviewer retrospectively reviewed the cases for patient diagnoses, demographics, related ethical issues and the actions of the MARC.
Result:
Each of the six patients required life-sustaining therapy, and each patient had a Do Not Resuscitate order on the chart. The MARC determined that it would be appropriate to withdraw life-sustaining support in four of the cases and to continue support in two of the cases. Five of the patients died in the hospital before discharge: two after discontinuation of support, one during the 10-day waiting period, and two died on full support after the Committee determined that continued treatment was medically appropriate. One patient was transferred to another hospital during the 10-day waiting period.
Conclusion:
These cases document the application of the TADA/MARC process in infants, even in circumstances where care was withdrawn without concurrence of the family. We found the MARC process to demand a very high degree of certainty of diagnosis and prognosis to determine continuation of care to be inappropriate. We conclude that the MARC promoted communication and provided additional protections to patients, families, physicians and staff.</description><identifier>ISSN: 0743-8346</identifier><identifier>EISSN: 1476-5543</identifier><identifier>DOI: 10.1038/jp.2008.58</identifier><identifier>PMID: 18596715</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Advance directives ; Advisory Committees ; Bioethical Issues ; Children ; Committees ; Demography ; Diseases ; Ethical aspects ; Ethics ; Families & family life ; Health services ; Hospital Mortality ; Humans ; Infant ; Infants (Newborn) ; Intensive care units ; Intensive Care Units, Neonatal ; Intensive Care Units, Pediatric ; Laws, regulations and rules ; Life Support Care ; Management ; Medical ethics ; Medicine ; Medicine & Public Health ; Neonatal intensive care ; Neonates ; original-article ; Patients ; Pediatric Surgery ; Pediatrics ; Physicians ; Professional-Family Relations ; Resuscitation Orders ; Retrospective Studies ; Waiting period ; Withholding Treatment - ethics</subject><ispartof>Journal of Perinatology, 2008-09, Vol.28 (9), p.641-645</ispartof><rights>Springer Nature America, Inc. 2008</rights><rights>COPYRIGHT 2008 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Sep 2008</rights><rights>Nature Publishing Group 2008.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c497t-bf806cde75b408127e8aa2ab4118e6ba412f04c1aee1d37bf308cb89ad498f3a3</citedby><cites>FETCH-LOGICAL-c497t-bf806cde75b408127e8aa2ab4118e6ba412f04c1aee1d37bf308cb89ad498f3a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18596715$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eason, E B</creatorcontrib><creatorcontrib>Castriotta, R J</creatorcontrib><creatorcontrib>Gremillion, V</creatorcontrib><creatorcontrib>Sparks, J W</creatorcontrib><title>Withdrawal of life sustaining treatment in children in the first year of life</title><title>Journal of Perinatology</title><addtitle>J Perinatol</addtitle><addtitle>J Perinatol</addtitle><description>Objective:
Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process.
Study Design:
A single reviewer retrospectively reviewed the cases for patient diagnoses, demographics, related ethical issues and the actions of the MARC.
Result:
Each of the six patients required life-sustaining therapy, and each patient had a Do Not Resuscitate order on the chart. The MARC determined that it would be appropriate to withdraw life-sustaining support in four of the cases and to continue support in two of the cases. Five of the patients died in the hospital before discharge: two after discontinuation of support, one during the 10-day waiting period, and two died on full support after the Committee determined that continued treatment was medically appropriate. One patient was transferred to another hospital during the 10-day waiting period.
Conclusion:
These cases document the application of the TADA/MARC process in infants, even in circumstances where care was withdrawn without concurrence of the family. We found the MARC process to demand a very high degree of certainty of diagnosis and prognosis to determine continuation of care to be inappropriate. We conclude that the MARC promoted communication and provided additional protections to patients, families, physicians and staff.</description><subject>Advance directives</subject><subject>Advisory Committees</subject><subject>Bioethical Issues</subject><subject>Children</subject><subject>Committees</subject><subject>Demography</subject><subject>Diseases</subject><subject>Ethical aspects</subject><subject>Ethics</subject><subject>Families & family life</subject><subject>Health services</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infant</subject><subject>Infants (Newborn)</subject><subject>Intensive care units</subject><subject>Intensive Care Units, Neonatal</subject><subject>Intensive Care Units, Pediatric</subject><subject>Laws, regulations and rules</subject><subject>Life Support Care</subject><subject>Management</subject><subject>Medical ethics</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neonatal intensive care</subject><subject>Neonates</subject><subject>original-article</subject><subject>Patients</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Physicians</subject><subject>Professional-Family Relations</subject><subject>Resuscitation Orders</subject><subject>Retrospective Studies</subject><subject>Waiting period</subject><subject>Withholding Treatment - 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ethics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eason, E B</creatorcontrib><creatorcontrib>Castriotta, R J</creatorcontrib><creatorcontrib>Gremillion, V</creatorcontrib><creatorcontrib>Sparks, J W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of Perinatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eason, E B</au><au>Castriotta, R J</au><au>Gremillion, V</au><au>Sparks, J W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Withdrawal of life sustaining treatment in children in the first year of life</atitle><jtitle>Journal of Perinatology</jtitle><stitle>J Perinatol</stitle><addtitle>J Perinatol</addtitle><date>2008-09-01</date><risdate>2008</risdate><volume>28</volume><issue>9</issue><spage>641</spage><epage>645</epage><pages>641-645</pages><issn>0743-8346</issn><eissn>1476-5543</eissn><abstract>Objective:
Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process.
Study Design:
A single reviewer retrospectively reviewed the cases for patient diagnoses, demographics, related ethical issues and the actions of the MARC.
Result:
Each of the six patients required life-sustaining therapy, and each patient had a Do Not Resuscitate order on the chart. The MARC determined that it would be appropriate to withdraw life-sustaining support in four of the cases and to continue support in two of the cases. Five of the patients died in the hospital before discharge: two after discontinuation of support, one during the 10-day waiting period, and two died on full support after the Committee determined that continued treatment was medically appropriate. One patient was transferred to another hospital during the 10-day waiting period.
Conclusion:
These cases document the application of the TADA/MARC process in infants, even in circumstances where care was withdrawn without concurrence of the family. We found the MARC process to demand a very high degree of certainty of diagnosis and prognosis to determine continuation of care to be inappropriate. We conclude that the MARC promoted communication and provided additional protections to patients, families, physicians and staff.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>18596715</pmid><doi>10.1038/jp.2008.58</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0743-8346 |
| ispartof | Journal of Perinatology, 2008-09, Vol.28 (9), p.641-645 |
| issn | 0743-8346 1476-5543 |
| language | eng |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Advance directives Advisory Committees Bioethical Issues Children Committees Demography Diseases Ethical aspects Ethics Families & family life Health services Hospital Mortality Humans Infant Infants (Newborn) Intensive care units Intensive Care Units, Neonatal Intensive Care Units, Pediatric Laws, regulations and rules Life Support Care Management Medical ethics Medicine Medicine & Public Health Neonatal intensive care Neonates original-article Patients Pediatric Surgery Pediatrics Physicians Professional-Family Relations Resuscitation Orders Retrospective Studies Waiting period Withholding Treatment - ethics |
| title | Withdrawal of life sustaining treatment in children in the first year of life |
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