Abstract
Rev Bras Ter Intensiva. 2007;19(3):359-363
DOI 10.1590/S0103-507X2007000300017
BACKGROUND AND OBJECTIVES: To analyze and discuss the medical practices related to the end-of-life care provided to children admitted to pediatric intensive care unit (PICU) in Brazil and in some countries located in the northern hemisphere. CONTENTS: Selected articles on end-of-life care published during the last years searching the PubMed, MedLine and LILACS database, with special interest on studies of death conducted in pediatric intensive care units in Brazil, Latin America, Europe and North America, using the following key words: death, bioethics, PICU, cardiopulmonary resuscitation and life support limitation (LSL). CONCLUSIONS: In North America and North Europe, the incidence of LSL is greater (60%-80%) than in south Europe and Latin America (30%-40%). In Brazil the incidence of LSL depends on the region and in the last decade it is increasing from 6% to 40%; being the do-not-reanimated order the most frequent mode of LSL. The family participation in the decision making process is not stimulated and incipient. Based on the literature review and on their experience the authors present the measures that they consider most efficient and recommended for managing this situation in our region. Despite of LSL in children with terminal and irreversible disease be considered ethically, morally and legally; these measures are still adopted in a very few circumstances in our region. Urgent changes in this behavior are necessary, specially related to family participation in the decision-making process.
Abstract
Rev Bras Ter Intensiva. 2007;19(3):364-368
DOI 10.1590/S0103-507X2007000300018
BACKGROUND AND OBJECTIVES: To analyze and discuss the medical aspects related to the family involvement in the decision making process regarding end of life care to children admitted to the pediatric intensive care unit (PICU). CONTENTS: The authors selected articles on end-of-life care published during the last years searching the PubMed, MedLine and LILACS database, with special interest on studies of death conducted in pediatric intensive care units in Brazil, Latin America, Europe and North America, using the following keywords: death, bioethics, PICU, decision-making, terminal care, parents interview and life support limitation (LSL). CONCLUSIONS: Several studies have demonstrated the relevance of the family participation in the decision making process regarding LSL. In our region the family participation in this process is not stimulated and valued, ranging from 20%-55%. The authors present a practical sequence for discussing and defining LSL with the families. Despite of the family participation in the decision making process for LSL be legally, morally and ethically accepted in developed countries, this approach is adopted in a very few cases in our region. To explain this difficulty observed among the Brazilian pediatric intensivist, some studies should be conducted in our region.